Friday, February 25, 2011

The Pleasures and Sorrows of Humiliation

I can never sleep on call. And I can never win: if the night is busy, with one emergency bleeding into another, I'm utterly miserable by 3 am, lusting after sleep like Garfield after lasagna and swearing at the (equally exhausted) surgeon for daring to question my iPod playlist. Conversely, on a rare call like tonight when Cape Town seems to be behaving itself, do you think I can get some shut-eye? Hell no. The hamster in my brain sees it as a clear sign to resume training for the Insomnia Olympics. I just realised I finished anaesthetising an appendicectomy at 1 am and now I've started this post past 5. I tossed and turned in the on-call room for three hours until giving up and trawling Wikipedia for essential information like the geology of Oceania and why the Turkish language could be related to Korean.

It's not that the on-call rooms are uncomfortable. I seem to have a knack for fund-raising and recently helped our department source hotel-quality beds for the registrars on night duty. (Frankly, I found it perverse that those who keep others asleep should be denied comfort in the rare chance they themselves could sleep.) For some reason, when a work night is quiet my body reacts as if I've won an espresso drinking competition.

I think it's remnant post-traumatic stress from med school where as a fourth-year I was thrown in the deep end during my first (and worst) clinical rotation and was brutally torn apart from the joys of nightly oblivion for the first time in my life. (There's a small scared voice running around in the labyrinth of my subconscious, feeling guilty because there's actually no work to be done for the moment.)

Let me take a deep breath and revisit a derelict side of Memory Lane. My fourth year obstetrics block was like being locked in a lurid Twilight Zone episode directed by Aronofsky, Hitchcock and Kubrick simultaneously, with a screenplay by Stephen King and shot in bad 80s direct-to-video transfer (for that extra fluorescent shine).  Contrary to popular belief, interns are not always the lowest form of life in the petri dish of medical academia. Not when there are students to abuse, as was the case at my alma mater.

In the labour ward, fourth years ran around in Shock and Awe, years before George W.'s regime used the words for military strategy. On paper we were supposed to assist and observe x number of deliveries. In reality our job was to do... everything, certainly everything boring or demeaning or exhausting, while being crapped on by the entire hierarchy. And no matter how efficiently you tried to do it, you'd be made to do it again, and then, when you thought you could finally sit down and possibly close your eyes for a bit you'd be made to do something inane to keep you awake - and everyone else went to bed. Our intern whom I remember as Mr Slick - he bathed in hair pomade - seemed to spend the entire call smoking and chatting up nursing staff - who, at this particular unit, were permanently on tea - pausing briefly to check up on (translation: rip to shreds) the 6th years who admitted new patients (actually, the intern's job). They in turn, riled and humiliated, would do everything in their power to make the youngest and most vulnerable students feel smaller and more fleeting than an antiparticle in a bubble chamber. All of this usually in front of a patient in labour. (On rare moments the registrar would appear to dispense wisdom to the intern.)

I'm not complaining about any of the actual work, understand, I'm just a little sore that since joining a different medical school for postgraduate study I've seen students (and interns) treated like... gasp... human beings for a change, and, shock, horror, they haven't automatically devolved into jellyfish for not going through some inane hazing ritual. There has been a sea change in the past decade with a gradual and refreshing realisation that letting exhausted medical personnel loose on patients is not perhaps the best standard of care. In my field it's been in practice for a while now. In the EU they've gone to the other extreme, with complicated working time directives regulating hours so strictly that trainees are not getting enough experience.

Not so when I was a fourth year. The final year students then, enjoying their first rush of superiority, were particularly cruel to their minions (us); it was high school all over again and we were newbies doing tricks and running errands for shits and giggles. Worse, it was a cowing conga-line of contempt: the intern would do the same to the final years, and the registrar to the intern, right up to the Professor broadcasting fear even as he slept in a hotel room thousands of miles away on some international congress. The law was a reversal of the Golden Rule: do it to others as it had been done to you. And so a succession of gradually lightening humiliation ensued until one day my undergraduate studies were over.

The sum of all these fears is that I don't remember anything about those twenty or so babies I delivered but instead a simpering tide of criticism and pettiness. The question was - would I do the same when I ascended the ranks to 6th year, intern and beyond?

No. And not that I'm a morally superior head boy either. Fate would have it that on my first final year call for obstetrics I pricked myself with a needle while assisting for a Caesarean section with an HIV positive patient and spent the rest of the block spaced out on antiretroviral medication and anti-emetics to counter the rolling waves of nausea they caused. There simply wasn't enough headspace available to even consider that there were others to humiliate. For whether the cocktail of AZT and 3TC fried my dictatorial neurons or not, I've never pursued the role of Great Dictator in any clinical scenario. Even today I am a Type B island in a Type A world. Difference is, where I am now - a thousand miles and seeming years from those student years - I'm generally tolerated; and the very least I can do is tolerate back.

Even if a student clearly doesn't even get basic physiology when you're metaphorically hitting them over the head with a textbook while trying to keep a patient asleep.

Even if a colleague interprets my lack of screaming and shouting during an emergency as being disinterested in my profession. (I may be disillusioned, but I've never thought I don't care.)

Even if all this is just a case of protracted sour grapes. If so, I think I've digested them well.

It's great getting this out there. It's going to be even greater to get into bed...

1 comment:

Dr Guinevere said...

I am sure you and I share the same alma mater as I too have very vivid memories of the perpetual system of unearned authoritarianism enforced through the ranks. In some departments a veritable reign of terror kept the wheel turning. I never saw the point of it, rather thinking that respect is earned and that professional adults should be able to conduct themselves in a dignified manner in relation to their colleagues whether of lesser or greater years' experience.

No one ever did anything about it because everyone was too scared to be the only one to rock the boat. When, as a final year rotation group in Obs and Gynae, we asked the professor if we could be excused from doing an overnight call and attending the next morning's 6 o'clock ward round on the day of our final O&G exams, he became beetroot red in the face, his flabby midgirth vibrated dangerously and slamming his fist on the table, he declared that students had been made to attend the ward round on the morning of their exams for 19 years and that was the way it would continue.

What I found most amazing is that, although we all found the professor's behaviour and reasoning apalling, many of us would in turn become just like him. I've seen this happen again and again. Well done for being the exception to the rule.