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.
Sunday, December 28, 2008
Saturday, December 13, 2008
Allergies
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.
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......
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......
Monday, November 17, 2008
Akela
I recently posted about my old scout master who probably was a pedophile and why we might not have seen the warning signs. The fact is there was somebody in our scouting community who was even weirder.
I talk about Akela. If you are unfamiliar with cubs; leaders in cubs are given names from Kipling's Jungle Book series. The head honcho is Akela, then it goes down the chain Baloo, Baghera, etc.
Our scout group at the tail end of the baby boom had enough cubs to make up two packs. These were known as A pack and B pack. Today there would be a stigma about being in B pack which is the pack my brothers and I went through. There wasn't then although A pack was clearly superior in every way. It was all attributable to their Akela. (Our pack had an Akela too , actually we had 2 different ones during the time I was a cub).
Akela was a 50ish gentleman, unmarried who lived with his mother. (Sound familiar?). She helped out with his cub pack and was given the title of Raksha. I'm not sure where in the hierarchy comes Raksha. She died sometime while I was still in cubs. Akela was born in England and had been an instructor at the military college but had retired early. I suspect there was some money in his family.
Our area of Victoria was by no means the slums, in fact it was probably the most affluent area of Victoria, however there were clear class differences. "A" pack were definitely a higher class of cub. Many of them had hyphenated names, quite a few of them went to private school, some had faux English accents. My mother when it was time for me to go into cubs for some reason tried to get me into "A" pack. She phoned Akela, who was quite positive until he asked her what school I went to. She told him and he made some lame excuse about why I couldn't be in his pack and I went into "B" pack. Apparently I came from the less right side of the tracks.
One of the ordeals of my cub career was the twice yearly soccer game against "A" pack. For the most part this meant getting thoroughly annihilated. One game we only had 10 players so "A" pack lent us their worst player who scored our only goal. Once we tied them which was a huge moral victory. After I left cubs, our Akela (Bkela?) got sick of being beaten and brought in ringers, kids who could actually play soccer and the beatings ended. They also beat us in softball and in floor hockey.
Overall even when at the time, it appeared that "A" pack was better organized and had a lot more fun than we did in "B" pack. Partially this was because Akela was retired and had time to do stuff, unlike our Akela who was just a parent of one of the cubs and had other commitments like a job. For example during the 3 summers I was in cubs we only had one summer camp because our Akela couldn't get the time off from work.
Which of course brings me to camp. Akela owned a large property about 30 minutes away. We camped there in Scouts and it was a fantastic location. It was wooded and a small river ran through it which was wide enough and deep enough to swim and dive it. Akela had built some tent platforms and a small building and his cub pack went out there a couple of times a year for a camp.
Once a year, "A" pack had a little party and slide show on a Saturday. One year my mother was asked to bake some squares and help out at the party (apparently A pack mothers didn't bake). She asked me if I wanted to come along, so I did, mostly so I could have some of her squares. Therefore I got to watch the slide show.
Aside from the slides documenting their humiliations of "B" pack on the soccer field, there were a number of slides of the camps out at Akela's property. Most of these slides were of the cubs swimming and it was quite apparent that nobody was wearing bathing suits. No they weren't swimming fully clothed, they were naked. Watching this slide show, were all the cubs parents, sisters, and who know how else.
And nobody thought this was unusual.
Now none of these pictures were graphic although you could see lots of pre-adolescent genitalia.
When I went to Scouts I got to know many of these cubs and it was something most people just laughed about. Apparently Akela and his mother strongly believed that swimming naked was in some way character building. Nobody ever said they had been touched inappropriately although it isn't something you bring up. Some people admitted to being embarrassed because girls in their class at school attended the slide show.
A few years later, one of the parents attended the slide show; complained and the skinny dipping stopped.
A few years later, Akela started up another cub pack labelled "C" pack who were children from a disadvantaged area of town. Every afternoon after school he would pick them up in the panel van our group had bought and drive them to and from the scout hall. He was trying to give them the same experience as his upper crust kids were getting. After a year or so, he went and asked the "group committee" would administered our group and raised funds for $10.00 for a party for his "C" pack. They turned him down and he resigned as Akela of "A" pack. I believe he continued on with "C" pack for a while after.
I was actually there the day he resigned. I was in Venturers and somebody had asked me if I could help out with his cub pack so I agreed. I suspected he was a bit of a pervert even then but I had talked to him a few times over the years and had sort of come to like and respect him. I helped out for about 2 months and had a lot of fun. He really liked his kids and he may have been a little tactile but never in the danger zones.
After he resigned, his pack went thru several leaders and probably folded. Things weren't the same.
He later donated his land to the local Scouts.
Again single man, lives with his mother, takes pictures of naked boys. Eccentric, that's all we thought in the 1960s.
I talk about Akela. If you are unfamiliar with cubs; leaders in cubs are given names from Kipling's Jungle Book series. The head honcho is Akela, then it goes down the chain Baloo, Baghera, etc.
Our scout group at the tail end of the baby boom had enough cubs to make up two packs. These were known as A pack and B pack. Today there would be a stigma about being in B pack which is the pack my brothers and I went through. There wasn't then although A pack was clearly superior in every way. It was all attributable to their Akela. (Our pack had an Akela too , actually we had 2 different ones during the time I was a cub).
Akela was a 50ish gentleman, unmarried who lived with his mother. (Sound familiar?). She helped out with his cub pack and was given the title of Raksha. I'm not sure where in the hierarchy comes Raksha. She died sometime while I was still in cubs. Akela was born in England and had been an instructor at the military college but had retired early. I suspect there was some money in his family.
Our area of Victoria was by no means the slums, in fact it was probably the most affluent area of Victoria, however there were clear class differences. "A" pack were definitely a higher class of cub. Many of them had hyphenated names, quite a few of them went to private school, some had faux English accents. My mother when it was time for me to go into cubs for some reason tried to get me into "A" pack. She phoned Akela, who was quite positive until he asked her what school I went to. She told him and he made some lame excuse about why I couldn't be in his pack and I went into "B" pack. Apparently I came from the less right side of the tracks.
One of the ordeals of my cub career was the twice yearly soccer game against "A" pack. For the most part this meant getting thoroughly annihilated. One game we only had 10 players so "A" pack lent us their worst player who scored our only goal. Once we tied them which was a huge moral victory. After I left cubs, our Akela (Bkela?) got sick of being beaten and brought in ringers, kids who could actually play soccer and the beatings ended. They also beat us in softball and in floor hockey.
Overall even when at the time, it appeared that "A" pack was better organized and had a lot more fun than we did in "B" pack. Partially this was because Akela was retired and had time to do stuff, unlike our Akela who was just a parent of one of the cubs and had other commitments like a job. For example during the 3 summers I was in cubs we only had one summer camp because our Akela couldn't get the time off from work.
Which of course brings me to camp. Akela owned a large property about 30 minutes away. We camped there in Scouts and it was a fantastic location. It was wooded and a small river ran through it which was wide enough and deep enough to swim and dive it. Akela had built some tent platforms and a small building and his cub pack went out there a couple of times a year for a camp.
Once a year, "A" pack had a little party and slide show on a Saturday. One year my mother was asked to bake some squares and help out at the party (apparently A pack mothers didn't bake). She asked me if I wanted to come along, so I did, mostly so I could have some of her squares. Therefore I got to watch the slide show.
Aside from the slides documenting their humiliations of "B" pack on the soccer field, there were a number of slides of the camps out at Akela's property. Most of these slides were of the cubs swimming and it was quite apparent that nobody was wearing bathing suits. No they weren't swimming fully clothed, they were naked. Watching this slide show, were all the cubs parents, sisters, and who know how else.
And nobody thought this was unusual.
Now none of these pictures were graphic although you could see lots of pre-adolescent genitalia.
When I went to Scouts I got to know many of these cubs and it was something most people just laughed about. Apparently Akela and his mother strongly believed that swimming naked was in some way character building. Nobody ever said they had been touched inappropriately although it isn't something you bring up. Some people admitted to being embarrassed because girls in their class at school attended the slide show.
A few years later, one of the parents attended the slide show; complained and the skinny dipping stopped.
A few years later, Akela started up another cub pack labelled "C" pack who were children from a disadvantaged area of town. Every afternoon after school he would pick them up in the panel van our group had bought and drive them to and from the scout hall. He was trying to give them the same experience as his upper crust kids were getting. After a year or so, he went and asked the "group committee" would administered our group and raised funds for $10.00 for a party for his "C" pack. They turned him down and he resigned as Akela of "A" pack. I believe he continued on with "C" pack for a while after.
I was actually there the day he resigned. I was in Venturers and somebody had asked me if I could help out with his cub pack so I agreed. I suspected he was a bit of a pervert even then but I had talked to him a few times over the years and had sort of come to like and respect him. I helped out for about 2 months and had a lot of fun. He really liked his kids and he may have been a little tactile but never in the danger zones.
After he resigned, his pack went thru several leaders and probably folded. Things weren't the same.
He later donated his land to the local Scouts.
Again single man, lives with his mother, takes pictures of naked boys. Eccentric, that's all we thought in the 1960s.
Role Models
One of the questions I ask prospective residents when I interview them is, "who are your non-medical role models?" Just to get them talking, nothing at all to do with their potential as an anaesthesiologist.
I have recently asked myself, who were my role models?
I can think of a few, my parents, a few teachers and....
My old scout master.
Scouting was a huge part of my childhood and adolescence. I was in Cubs, Scouts and Venturers from the time I was 8 until I graduated from high school. The most formative years were however from 11-14 when I was in scouts.
Our scout master liked to be called by his first name. In the 1960s having an adult who let non-adults call him anything other than Mr. was unusual. His first name was Dave and I will call him that for the rest of this blog.
Dave was born in England and had moved to Canada with his parents as a young adult. He was still not married and lived with his parents. Dave ran the scout troop. Other adults and few older teenagers helped out from time to time but it was Dave's show.
We had our meetings every Thursday evening. These were incredibly well organized evenings chock full of several interesting activities all planned by Dave. Every Saturday morning he came to the scout hall for those of us who wanted to pass tests or earn badges. Every couple of months we had a hike on a Saturday or Sunday. We also had weekend camps about three times a year and in the summer we had a 9 day camp in the mountains.
Dave was a real hiking and camping enthusiast. He was big into light weight camping where you packed in all your gear. The idea was to be as comfortable as possible while still carrying in almost everything. We often had over 30 people per camp so every camp was a major military operation supervised by Dave.
Periodically we had "wide games" which were huge operations based on variations of "capture the flag" or a treasure hunt. These were also elaborately organized and some of them must have taken days to set up.
Dave's effect on the troop was such that our troop had over 40 scouts at a time when Scout troops all over the area were folding.
Dave also helped out perioidically with the Venturers, was involved in the local hiking club and was involved as a Big Brother.
Dave was soft spoken, when not in scout uniform (which he wore with short pants and knee socks) he was always well dressed. There was a story that he broke up with a rare girlfriend because she wore jeans to his parents house. He drove a Rover. He was an enthusiastic landscape photographer and had an SLR camera which weren't very common in the 1960s (and was the first thing I purchased when I finally had money). If you had a problem, he was always willing to talk things out and could be very philosophical.
As I said he was a huge influence on my life. I wish I could say that this was the start of a life-long commitment to camping, hiking and mountaineering; sadly while I enjoy looking at mountains, I don't really like climbing and I enjoy my bed too much.
I went up to Venturers at 15 (I stayed an extra year in Scouts, I liked it so much). About a year later, Dave who worked for the government was transferred to another town. He got right into the local Scouting movement and the next summer his new troop had a joint summer camp with his old troop.
I last saw him when I was 20. I was coming home for a break from my summer work and was on the ferry home. He was also visiting his parents. We sat together and talked for the whole trip. It was like two old friends talking together. I have never seen him since.
I went to medical school, kicked around in various places in Canada and I was living in Eastern Canada when I heard that he had been charged and pleaded guilty to sexually abusing one of his scouts. He spent some time in prison. I was out of the province so I missed any media coverage and I have lost contact with just about all of my scouting buddies. I have talked it over with my older brothers who preceded my in Scouts. One says there is no way he was guilty; the other says, of course he was guilty. My father believes he pleaded guilty in order to prevent the child who accused him from having to testify and be cross-examined. I have a hard time believing anybody would willingly go to jail as pedophile.
Now looking back, maybe it should have been obvious. We have a quiet soft spoken man who lives with his parents, is heavily involved in Scouting and Big Brothers, doesn't have a girlfriend, and likes to take pictures. Perfect profile of a pedophile? This was the 1960s; there were lots of men like him and they were largely respected in the community. When I was writing this blog, I googled him and all I could find a was an award for distinguished service to scouting in 1969.
All I can say is he never touched me (maybe I was lucky) and I never ever heard anything untoward about him from any of my friends although being diddled by your scoutmaster isn't something teenagers brag about. One time in Venturers we were hiking up in the mountains and we came across him camping with his Little Brother. In 1973 we didn't think that was unusual.
About 5 years ago our scout troop had a reunion. It was on a weekend and while I wasn't working, it would have meant flying there so I didn't go. I just thought it would be a whole lot of people I had nothing in common with anymore trying to make conversation. The whole uneasiness about Dave played a role. One of my brothers attended and said it was a lot of fun and that Dave was there.
About a month later, I got a letter from Dave. He said that he was now retired and living with his wife(!) on one of the Gulf Islands. I meant to write hime back to tell him what a good role model he had been for me but the letter disappeared into a black hole on my desk and I never did write the letter. I lost his address too.
I attended a workshop on hypnosis last spring and we talked about forgiveness. The speaker said it is possible to forgive somebody without condoning what they did. I cannot condone anybody who uses a position of authority to hurt somebody, especially a child. I can forgive him however for what he did to that child and for the doubts he has raised about my whole Scouting experience.
I have recently asked myself, who were my role models?
I can think of a few, my parents, a few teachers and....
My old scout master.
Scouting was a huge part of my childhood and adolescence. I was in Cubs, Scouts and Venturers from the time I was 8 until I graduated from high school. The most formative years were however from 11-14 when I was in scouts.
Our scout master liked to be called by his first name. In the 1960s having an adult who let non-adults call him anything other than Mr. was unusual. His first name was Dave and I will call him that for the rest of this blog.
Dave was born in England and had moved to Canada with his parents as a young adult. He was still not married and lived with his parents. Dave ran the scout troop. Other adults and few older teenagers helped out from time to time but it was Dave's show.
We had our meetings every Thursday evening. These were incredibly well organized evenings chock full of several interesting activities all planned by Dave. Every Saturday morning he came to the scout hall for those of us who wanted to pass tests or earn badges. Every couple of months we had a hike on a Saturday or Sunday. We also had weekend camps about three times a year and in the summer we had a 9 day camp in the mountains.
Dave was a real hiking and camping enthusiast. He was big into light weight camping where you packed in all your gear. The idea was to be as comfortable as possible while still carrying in almost everything. We often had over 30 people per camp so every camp was a major military operation supervised by Dave.
Periodically we had "wide games" which were huge operations based on variations of "capture the flag" or a treasure hunt. These were also elaborately organized and some of them must have taken days to set up.
Dave's effect on the troop was such that our troop had over 40 scouts at a time when Scout troops all over the area were folding.
Dave also helped out perioidically with the Venturers, was involved in the local hiking club and was involved as a Big Brother.
Dave was soft spoken, when not in scout uniform (which he wore with short pants and knee socks) he was always well dressed. There was a story that he broke up with a rare girlfriend because she wore jeans to his parents house. He drove a Rover. He was an enthusiastic landscape photographer and had an SLR camera which weren't very common in the 1960s (and was the first thing I purchased when I finally had money). If you had a problem, he was always willing to talk things out and could be very philosophical.
As I said he was a huge influence on my life. I wish I could say that this was the start of a life-long commitment to camping, hiking and mountaineering; sadly while I enjoy looking at mountains, I don't really like climbing and I enjoy my bed too much.
I went up to Venturers at 15 (I stayed an extra year in Scouts, I liked it so much). About a year later, Dave who worked for the government was transferred to another town. He got right into the local Scouting movement and the next summer his new troop had a joint summer camp with his old troop.
I last saw him when I was 20. I was coming home for a break from my summer work and was on the ferry home. He was also visiting his parents. We sat together and talked for the whole trip. It was like two old friends talking together. I have never seen him since.
I went to medical school, kicked around in various places in Canada and I was living in Eastern Canada when I heard that he had been charged and pleaded guilty to sexually abusing one of his scouts. He spent some time in prison. I was out of the province so I missed any media coverage and I have lost contact with just about all of my scouting buddies. I have talked it over with my older brothers who preceded my in Scouts. One says there is no way he was guilty; the other says, of course he was guilty. My father believes he pleaded guilty in order to prevent the child who accused him from having to testify and be cross-examined. I have a hard time believing anybody would willingly go to jail as pedophile.
Now looking back, maybe it should have been obvious. We have a quiet soft spoken man who lives with his parents, is heavily involved in Scouting and Big Brothers, doesn't have a girlfriend, and likes to take pictures. Perfect profile of a pedophile? This was the 1960s; there were lots of men like him and they were largely respected in the community. When I was writing this blog, I googled him and all I could find a was an award for distinguished service to scouting in 1969.
All I can say is he never touched me (maybe I was lucky) and I never ever heard anything untoward about him from any of my friends although being diddled by your scoutmaster isn't something teenagers brag about. One time in Venturers we were hiking up in the mountains and we came across him camping with his Little Brother. In 1973 we didn't think that was unusual.
About 5 years ago our scout troop had a reunion. It was on a weekend and while I wasn't working, it would have meant flying there so I didn't go. I just thought it would be a whole lot of people I had nothing in common with anymore trying to make conversation. The whole uneasiness about Dave played a role. One of my brothers attended and said it was a lot of fun and that Dave was there.
About a month later, I got a letter from Dave. He said that he was now retired and living with his wife(!) on one of the Gulf Islands. I meant to write hime back to tell him what a good role model he had been for me but the letter disappeared into a black hole on my desk and I never did write the letter. I lost his address too.
I attended a workshop on hypnosis last spring and we talked about forgiveness. The speaker said it is possible to forgive somebody without condoning what they did. I cannot condone anybody who uses a position of authority to hurt somebody, especially a child. I can forgive him however for what he did to that child and for the doubts he has raised about my whole Scouting experience.
Sunday, November 16, 2008
I Was a Medical Criminal Part III
Just a note that after venting on my blog, I did what someone described as the closest thing an Englishman will do to rebelling, I wrote a letter. I wrote a letter to the chief of staff for the region.
A few days later, his executive assistant phoned me and wasn't really helpful BUT a month later I actually got a signed letter from the Chief of Staff himself, appologizing for the whole incident.
So I am no longer an medical records criminal.
A few days later, his executive assistant phoned me and wasn't really helpful BUT a month later I actually got a signed letter from the Chief of Staff himself, appologizing for the whole incident.
So I am no longer an medical records criminal.
Saturday, November 15, 2008
Am I a Luddite
Technology was supposed to make life simpler for us. In some ways it has. I would never want to go back to submitting my billing on paper; paying my dues on-line is easier and of course if I wasn't writing this stupid blog, I would actually feel obliged to do some work.
A couple of new technological hurdles are making me wonder however.
At a recent staff meeting, a member raised a concern about our new anaesthetic machines. Apparently in our case room we have the newest generation Drager machine. It is in the case room because for some reason Ob-Gyn "paid" for it. The problem with this machine is that if it is turned off, it takes literally 30 minutes for the software to boot up.
So don't turn it off you say.
Unfortunately for infection control reasons all operating rooms are terminally cleaned once a day which means moving all the equipment into the hall. This means unplugging the anaesthetic machine which unlike my laptop, doesn't have a back-up battery. (My laptop also plays music and surfs the internet unlike my anaesthetic machine.) Therefore unless somebody turns it back on, when you show up at 0300 for the prolapsed cord, the machine will not work. Now there is a process where you can "hot boot", the machine however the manufacturer warns that after 10 hot boots, the software will be damaged.
Our department has exclusively Drager machines in the main OR which also have a boot up process after being unplugged but it is possible be randomly pushing at buttons to bypass this.
Does all this software make anaesthesia safer. No.
Gather round children while Grandpa tells you about anaesthesia in the olden days.
We had machines that were essentially copper pipes with valves. They were driven by the compressed gas from the central supply or from the O2 cylinder. And they were safe. If the compressed O2 failed, the N20 which was held open by the gas pressure also shut off, and a loud whistle sounded. There was a mechanical link which automatically reduced the N2O when the O2 flow was reduced and in addition it was impossible (on most machines) to completely turn the O2 off. You didn't need to plug them in to an electrical socket which meant you could if you were stupid enough or where forced to, move them with the patient to another room using the O2 cylinders. Oh yeah the O2 also drove the ventillator.
Now the greatest advance in patient safety in my lifetime was the invention and adoption of pulse oximetry. Not newer more elaborate machines that need to the plugged in to the wall socket and have finicky software. Not to mention those annoying alarms. Talk about crying wolf.
A year or so ago I went down to Ecuador. While there I went over to another hospital to do a case. In the room we were given I encountered an old Ohio machine. Some people would have fled the room in horror but I had actually used a similar machine, I was able to inspect it quickly, ascertain that it was in working order (and I am not very good with machines) and I knew that with a pulse oximeter, I would be able to give a very safe anaesthetic. Later that evening I recounted my adventure to a slightly younger anaesthetist who recoiled in horror at using a machine that in his words should be in a museum.
The second issue was the new Smart Pumps our hospital now has.
These are computerized infusion pumps designed to prevent medication errors. During the early fall nurses had to attend inservices lasting several hours to learn to use these machines. As anaesthesiologists we alone amongst physicians have to adjust these pumps we tried to get an inservice. I spent a great deal of time with the company explaining why we needed a full inservice (instead of just looking at them between cases which was what they offered). As it turned out I had to miss the inservice so I still in the dark about how to adjust these pumps. Again do these expensive and time consuming pumps improve patient safety.
No.
Will still there be medication errors?
Yes.
This reminds me that my wife who recently recertified as a nurse actually had to learn how to calculate flow rates by counting drips. She asked my about this. I told her it showed just how long it had been since most academic nurses had actually been in a hospital because nobody does that anymore.
A couple of new technological hurdles are making me wonder however.
At a recent staff meeting, a member raised a concern about our new anaesthetic machines. Apparently in our case room we have the newest generation Drager machine. It is in the case room because for some reason Ob-Gyn "paid" for it. The problem with this machine is that if it is turned off, it takes literally 30 minutes for the software to boot up.
So don't turn it off you say.
Unfortunately for infection control reasons all operating rooms are terminally cleaned once a day which means moving all the equipment into the hall. This means unplugging the anaesthetic machine which unlike my laptop, doesn't have a back-up battery. (My laptop also plays music and surfs the internet unlike my anaesthetic machine.) Therefore unless somebody turns it back on, when you show up at 0300 for the prolapsed cord, the machine will not work. Now there is a process where you can "hot boot", the machine however the manufacturer warns that after 10 hot boots, the software will be damaged.
Our department has exclusively Drager machines in the main OR which also have a boot up process after being unplugged but it is possible be randomly pushing at buttons to bypass this.
Does all this software make anaesthesia safer. No.
Gather round children while Grandpa tells you about anaesthesia in the olden days.
We had machines that were essentially copper pipes with valves. They were driven by the compressed gas from the central supply or from the O2 cylinder. And they were safe. If the compressed O2 failed, the N20 which was held open by the gas pressure also shut off, and a loud whistle sounded. There was a mechanical link which automatically reduced the N2O when the O2 flow was reduced and in addition it was impossible (on most machines) to completely turn the O2 off. You didn't need to plug them in to an electrical socket which meant you could if you were stupid enough or where forced to, move them with the patient to another room using the O2 cylinders. Oh yeah the O2 also drove the ventillator.
Now the greatest advance in patient safety in my lifetime was the invention and adoption of pulse oximetry. Not newer more elaborate machines that need to the plugged in to the wall socket and have finicky software. Not to mention those annoying alarms. Talk about crying wolf.
A year or so ago I went down to Ecuador. While there I went over to another hospital to do a case. In the room we were given I encountered an old Ohio machine. Some people would have fled the room in horror but I had actually used a similar machine, I was able to inspect it quickly, ascertain that it was in working order (and I am not very good with machines) and I knew that with a pulse oximeter, I would be able to give a very safe anaesthetic. Later that evening I recounted my adventure to a slightly younger anaesthetist who recoiled in horror at using a machine that in his words should be in a museum.
The second issue was the new Smart Pumps our hospital now has.
These are computerized infusion pumps designed to prevent medication errors. During the early fall nurses had to attend inservices lasting several hours to learn to use these machines. As anaesthesiologists we alone amongst physicians have to adjust these pumps we tried to get an inservice. I spent a great deal of time with the company explaining why we needed a full inservice (instead of just looking at them between cases which was what they offered). As it turned out I had to miss the inservice so I still in the dark about how to adjust these pumps. Again do these expensive and time consuming pumps improve patient safety.
No.
Will still there be medication errors?
Yes.
This reminds me that my wife who recently recertified as a nurse actually had to learn how to calculate flow rates by counting drips. She asked my about this. I told her it showed just how long it had been since most academic nurses had actually been in a hospital because nobody does that anymore.
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