Failures - yours and mine

After my cervical cancer screening practicum, which ended at around 5pm, I went to Ward 4A to find Dr. Etolu and see if he had any LP’s for me to do. Unfortunately, he didn’t. He also had to go meet with his consultant to go over some cases, and I told him I would just wait for him on the floor. I wanted to hang out a little with him before I left for Mubende. I didn’t how long I would be gone, or when I’d get to work with him again.

So I decided to make myself useful on the floor. I went to help Dennis with his work. He had recently switched over to the GI ward (still in Ward 4A), and was still finishing up rounds. “What have you been doing all day?” I asked him. “It was a tough day. The consultant came to round with us, questioning our every clinical decision, and we had to defend our diagnoses and treatment plans. Long day.” Well, at least the consultant bothered to show up, I thought. And it sounded like he even made a decent effort to teach! But I did understand how everything took longer with the consultant rounding, so I did my best to help him out.

I did all the blood draws, filled out all the lab request forms, even wrote some of the notes for him. I ran the samples to the lab downstairs, more blood draws, more samples to the lab. We had two patients with severe anemia secondary to upper GI bleeding. Blood draws, type and cross, request for 2 units of packed RBCs (though we almost invariably get whole blood). And then a third patient with the same thing. As I was running down the third sample to the haematology lab, the first patient’s blood was ready for collection. I picked up one unit first (following the advice of the lab technician, who told me that the second packet usually just lies on the patient’s bed overnight, and it would spoil overnight; he advised me to just transfuse the second unit the following morning), warmed it against the patient’s body (he was feeling hot, and welcomed the cool respite from the icy cold packet of blood, so it worked out well for all parties), and hooked it up to the patient’s IV line. I went down to check on the other 2 patient’s blood. They were both O+, and we were out of O+ blood. One of the lab technicians had gone to an elusive “somewhere” to try and obtain more blood. ETA – maybe around an hour.

I went back to the floor to report this to Dennis. It was close to 8pm. I was exhausted, I was starving, I had to do laundry tonight in order for my clothes to dry in time for my trip to Mubende, and I had to wake up at 6.30am the next morning for the long journey to MildMay hospital. I was ready to call it a day. But Dennis, as it turned out, had already left. He had three patients on his ward with severe anemia secondary to upper GI bleeding, whom he had requested urgent transfusions for, and he had left for the day. This was his ward, these were his patients. I didn’t even work here. I was so angry. He had left me in a terrible position. Either I could stay the hour (and when they say one hour, it will most likely be closer to two), and collect the blood – basically do the responsible thing, do his job for him, or I could just go home, and the patients would suffer. I did a few quick calculations in my head. It would definitely not be safe for me to walk home at 10pm by myself. The patients would almost definitely survive the night, barring any massive hemorrhages overnight, in which case a unit of blood now wouldn’t help them anyway. I called Dr. Etolu – he was still with the consultant. I told him I was exhausted and heading home. I was too angry to even tell him about what had happened on the ward. Then I walked home feeling like the most irresponsible, selfish doctor in the world.