jamaican health care

Day in the Life of a Paediatric Intern

Robyn, , , 5 Comments

This post originally titled, Waving the White Flag. (It’s Kleenex).

Where to start with Paediatrics? The current headlining scandal? The mind-numbing, soul-crushing duties? The prickly staff? The demanding work days? How about all of it, all at once, the way it is in real life. Nothing about this rotation happens in an orderly fashion. One time our senior registrar scolded us for not completing discharge summaries on time, saying “they are just as much a priority as dealing with procedures for patients on the ward and from clinic and giving medications”. If it’s one thing Paeds has taught me, it’s that everything can be a priority, all at the same time.

But all this non-stop action has succeeded in murdering my already feeble immune system so that I am now sick. With the flu. Probably. Or tuberculosis. Probably (not). If you know anything about me, it should be that I do not handle illness well. I handle it like a boy, really. Which is probably sexist to say but we all know it’s true. Boys are complete babies when they get sick. And so am I. I curl up in the foetal position and demand soup in a voice that sounds like death colded over*. I am utterly useless at anything involving physical, mental or emotional energy and I sometimes fantasise about using telekinesis instead of getting up to retrieve my phone from the counter five feet away.

Going to work today was entirely out of the question, so I used my leftover energy to feel guilty about calling in sick. I know what a Paediatric work day is like. I also know that I have duty tomorrow and I had to make the decision to take today off so that I could have some reserve of energy with which to survive that 36 hour beat.

This is what a Paediatric work day is like for me:

Starts at 8AM (unlike Surgery which would start at 6:30-7 because the earlier you arrive, the earlier you leave. On paeds you leave late no matter what). At 8AM you see patients on the ward until ward rounds start at about 9:30.

Ward rounds end at about 11AM when you start the day’s procedures which include taking blood, collecting urine samples and sending patients for investigations (like xrays etc). This is for patients admitted on the ward, as well as patients here for the day for a review or patients sent up from clinic.

All intravenous medications are administered by the interns, on a strict schedule. Medication also has to be ordered daily from the pharmacy because they don’t send up more than one day’s supply. This means writing up several charts and getting your senior house officers (SHOs) to sign them because your signatures carry no weight.

Then there is other paperwork like writing discharge summaries and prescriptions for the patients leaving. And there is following up of lab results, mostly cultures from microbiology, that require one of you to go into the lab for about an hour to write down results from the 3-4 books that serve as records.

All this takes you until well into the afternoon and suddenly it’s 3PM and you haven’t stopped for lunch. You just gave the 2PM medication but you can’t eat yet because this baby needs an intravenous access (a ‘drip’) and another baby just got admitted from Accident and Emergency (A&E) needing blood and urine cultures.

There are three of you working but it doesn’t seem like enough. The SHOs will ask “Are you the only one doing procedures? Where’s Dr. So-and-So?” and you will calmly explain that Dr. So-and-So is giving medication while Dr. What’s-Her-Face is in A&E seeing referrals and there’s no one left to help you and they will press their lips together and give you a look which you’re pretty sure does NOT mean “That sounds rough, I’ll help you” and instead means “Well. You’re just gonna have to get your shit together” and you move on with your day. Breathe and move forward should be the mantra of Paediatrics.

After you finish procedures, following up the regular lab results for the samples you took off in the day can take you beyond 4PM because some result always comes back abnormal and needs to be acted on. I don’t like to leave that kind of work on the duty intern because duties are rough enough without adding work that’s carried over from in the day. So I never end up leaving before 6PM and usually leave around 8PM.

I’m not going to get into my eating habits because my aunt reads this blog and would probably have a conniption but suffice to say I would not turn down the offer of a live in chef. Or maid. Or professional masseuse. Or all three in one so I’d only have one monthly fee. Am I setting the bar too high?

Fuck it. The bar was high before I even got here. This whole time I’ve been trying to brush it with my fingers, on tiptoe, stretching furiously toward some untouchable standard. Today I got to rest my aching body/mind/soul for a teensy bit. Tomorrow it’s back to the rack.

Flecti non frangi.

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(*Because death warmed over sounds a little too pleasant. Like Death already got soup and a blankie and now he’s pleased as punch. Although I have been told that my sick voice sounds very sultry so maybe my voice actually is warmed over).

Of Scandals and Sheer Bloody-mindedness

Robyn, , , , Leave a comment

For several weeks late last year the hashtag ‘deadbabyscandal’ was splashed all over social media. At the time I was studiously avoiding any news or public opinion on the topic because I was working in the midst of the neonatal department at one of the hospitals involved. I was already getting a lot of emotional backlash at work from my superiors (it having trickled down from the public) – I didn’t need it firsthand.

The first time I looked up any information at all on this topic was when one of my fellow intern/blogger (barefootmeds, she’s awesome. Go say hi) asked for details, which I will share here. Newspaper articles, because now that I work for the government I’m legally obligated to keep their secrets (or some shit like that).

This is how it started: Four Months, Eight Babies Dead.

And then it got worse: Another Baby Dies at Cornwall Regional.

And then someone said something they shouldn’t have: Ferguson Sorry for ‘Not Real Babies’ Comment.

And it only continued to escalate: Backlash Over Dead Baby Scandal because babies and conspiracy theories are a social minefield.

Here is a handy timeline of the hospitals’ responses.

To which I have only the following to add (as a soldier working on the front-line, whose opinion the crowd back home rarely ever wants to hear).

  1. The death of a baby is and will always be a tragedy. It is a horrible, horrible thing.
  2. An approach that was more solution oriented rather than blame oriented would have been infinitely preferable – and this was the approach taken by our Head of Dept and other consultants. Contrast the approach taken by politicians.
  3. Outbreaks happen a lot, especially in critical care areas, and largely because we have an imperfect system that is overburdened and understaffed.

It is a sad truth of our society that change is only galvanized by conflict. That the things which are broken are never addressed until something terrible happens, and even then we can expect a patchwork job at best.

The nine day wonder that this tragedy was paraded as has created some minor changes, yes, but the over-extended structure of our health care system still stands poised to collapse under the pressure. As our politicians preen and pontificate in preparation for the upcoming elections, this tragedy becomes nothing more than mud to be flung and then swept under the rug. When will we forget the curry goat/Red Stripe and the dancehall gatherings masquerading as political rallies and remember what really matters?

The same people who pile up in the Accident and Emergency Department demanding shorter waiting times and more bed space from the hospital staff (who have no say in the matter) neglect to hold accountable the people with the power to actually effect change. On election day they do the same thing they have always done; at the rallies they cheer and stomp and revere, ask no hard questions, make no demands. They they get shot or get sick and they get upset at us in the public system for not having the drugs they need in stock, for not having the right equipment to save their lives.

Jamaican people are the ones swatting violently at the mosquito while sinking knee-deep, waist-deep, neck-deep in quicksand. But don’ worry, mosquito soon stop bite you.