Unpleasant exchange

After a long day in theatre, I went to Ward 4A to check on Joyce. She was one of the new interns who had just started work in Mulago on Tuesday, and had been fortunate enough to be assigned to Ward 4A – Infectious Diseases. I had met her when I went to 4A on Tuesday to visit Dr. Etolu and help out on the ward. She had seemed quite lost and confused, but she was such a sweet girl. We had dinner together with Dr. Etolu at the Doctor’s cafeteria, and quickly became friends.

She had a Tetanus patient who was really really sick. The patient had not been feeding for days, and she was worried about the nutritional status of the patient. She had written the patient for 50% Dextrose TID, but the patient needed to get some food soon. Total Parenteral Nutrition was non-existent here. I received blank stares when I suggested it as an option. And so we had given the patient some Diazepam to reduce the spasms, and tried to pass an NG tube. However, the patient started gurgling and foaming at the mouth almost immediately when we inserted the NG tube, and his breathing had become so compromised that we were forced to stop. After removal of the NG tube, he seemed to be breathing better. The nurse suggested we find an anesthetist to come intubate the patient to protect his airway before we attempt to insert the NG tube again. Since it was after 5pm, the only anesthetist on duty would be the one in the Emergency theatre, so Joyce and I went there to plead our case for some assistance. There was no anesthetist there, and nobody had any idea when he/she would arrive. Yes, we were at Mulago – the National Regional Referral Hospital, and there was not a single anesthesiologist or anesthetist around. So if some poor patient comes in hemorrhaging from a ruptured spleen? Tough luck, can’t do an ex-lap with no anesthesia. Of all the travesties that I had seen here in Mulago, this had to be the absolute worst.

Anyways, that was yesterday. We had left the patient with 50% Dextrose hoping his condition would improve. It didn’t. In fact, his condition had deteriorated. Today, even without the NG tube, he was having frequent laryngospasms, and we were worried that he would clamp off his airway just long enough to induce death. Joyce wasn’t sure he would survive the night without intubation. So we went back to Emergency theatre, hoping that our luck would be better this time. It wasn’t. In fact, not only was the anesthetist not there, there were 3 emergency cases waiting to go back, so even if he/she arrived, he/she wouldn’t be able to help us. The surgery resident, Robert, waiting to go back with his 3 emergency cases was actually on my team. My team had been on call the night before (I hadn’t taken call, secondary to a lack of call room, and I wasn’t prepared to walk home alone after midnight), and he had been here all night taking call, and all day waiting to complete his cases. He was now exhausted, famished, utterly sleep-deprived, but waiting for the anesthetist to come so he could complete his cases. His patients needed him, so he would stay for them. I admired his spirit great. He understood our plight, and suggested we try the ICU – intensivists generally know how to intubate. What a great idea!

Joyce went back to the floor to finish up some work, and I proceeded to the ICU to beg for help. When I got there, one of the sisters directed me to the doctor. I greeted her, and explained the situation to her, asking very very nicely if she could help us. I emphasized the fact that we were worried the patient would not survive the night if he were not intubated. The whole time I was talking to her, she simply kept writing in her chart, not looking up at me even once. When I finished talking, she threw down her pen in a fury and narrowed her eyes at me. “There are protocols to follow for these things!” she yelled. “Why did they send you, a mere visitor, to come talk to me? Who is your intern? She should know better. I’m all alone here, and I have very sick patients! I can’t go running all around the hospital intubating whoever needs to be intubated! Your intern would know to call the anesthetist on duty, who can come help you!”

I looked at her with utter bewilderment. A “no I’m too busy to help you” would’ve been fine. Why did she have to yell at me? “I don’t know what I did to make you so angry at me, but I’m a part of the medical team,” I told her calmly. “I’m not just a visitor. I’m a medical student. I take care of my patients, I take responsibility for them. And with all due respect, I’ve been here longer than the interns have, and know this hospital as well as its protocols better than they do.” “I’m not angry at you,” she continued yelling. Really? She could’ve fooled me. “But there are protocols. And you’re just a visitor. You students come here and you want to do everything. But you don’t know anything. The interns, they have 5 years of medical school experience. They know what to do. They know that they have to call the anesthetist on duty for these things!” Seriously? Did she just seriously say that I didn’t know anything?

“Listen, we tried to get the anesthetist on duty. In fact, we went to the Emergency theatre, but there’s no anesthetist there. They’re waiting for the anesthetist on duty too. And there are 3 emergency cases waiting, so even when the anesthetist comes, he can’t help us. The people in the Emergency theatre suggested we come here for help. That’s why I’m here. We’re out of options. This was our last resort.” She started writing in her chart again. “There are PROTOCOLS!” she screamed at her chart now. “They have to be FOLLOWED!!!! I can’t help the whole hospital.” “Okay then. Can we transfer our patient here to the ICU?” “No there are no beds available.” “Can we borrow intubation equipment to intubate our patient ourselves?” “No! Where is your intern? I can’t believe they sent a visitor!” “I’m sorry you’re so angry,” I told her, my voice raising in anger and frustration as well. “But I’m just here because I’m trying to do what’s best for my patient.” “I’m trying to do what’s best for my patients too!” she retorted. “All right. Thanks for your time.” I left and let the door slam shut behind me.

About 15 minutes later, I went back to get her name, so that I could file a formal complaint against her. People should not be allowed to talk to other people like that. I don’t care who you are, you should treat others with courtesy and respect. Or at least not yell at them for no good reason, telling them that they don’t know anything, and making them feel like trespassers on your personal property. But she was no longer there. She had left her seriously ill patients – all twelve of them – and gone home. So much for trying to do what’s best for her patients. And if they’re not her patients, they can live or die for all she cares.

I did get her name from one of the nurses – Dr. Jane Nakibuka, the head of the Intensive Care Unit. She was not only the most unpleasant physician I had ever come across, she was quite possibly the most unpleasantly-mannered human being I had ever met. I comforted myself with the thought that maybe she had had a really rough day, and was not usually like that. Perhaps she was just a decent person having a bad day. I went back to Emergency theatre to check on Robert. He was still waiting for the anesthetist, though rumor had it that he was on his way. Robert was very optimistic that the anesthetist would arrive within the hour. I stayed and chatted with him for a while, and told him of my unpleasant experience in the ICU. Robert laughed. He knew exactly who I was talking about. He had rotated through the ICU and had had a similarly unpleasant experience. Apparently, Dr. Nakibuka won’t give anyone below her level the time of day, won’t even glance at the residents, much less teach them. But she is super nice and sweet with her peers and superiors. She even chats and laughs with them. She knows how to laugh?!! So she’s definitely not a decent person having a bad day. Final verdict – Class A BITCH.