In my adult life, I have been this angry very few times. I am literally seething. I know anger is unhealthy, but in my shoes, I doubt anyone would feel any less angry.
Thomas Jefferson said to count till ten if angry, before speaking and to count till hundred if very angry. I have been counting for the past 2 days now- so that I can write, without breaking my keyboard.
This Monday, something happened. I was fresh from 4 consecutive days of back to back calls. I managed to get some sleep on Sunday night, so I was exhausted, but not threadbare. It was in the late afternoon and our working day was drawing to a close. My unit had come to the Accident and Emergency to attend to one of our patients who had not yet been moved to the ward (ask me why later). We were supposed to do fundoscopy on him before proceeding to carry out a lumbar puncture, but we couldn’t find a functional ophthalmoscope. My senior resident had gone out to try to find one and we were reviewing our patient’s records when someone came to call me- doctor! doctor!! It was a relative of the patient next to mine.
The patient was on a cervical collar and I asked if he had been in an accident. His brother who had come to call me was already crying, but he managed to shake his head no. I asked if he had fallen from a height, he nodded. I asked again, if he landed on his head or back, he motioned to his side, I asked which side, he didn’t know. As usual, there were no patient notes bedside, so, to this day, I don’t even know that young man’s name. I noticed though that although the patient was on oxygen, his airways appeared to be blocked. The head of the bed was slightly raised, and that put his head in an awkward position, especially with the collar on. That, plus his oral secretions were bubbling out of his mouth and his tongue was flailing. The bed controls were all missing or nonfunctional, so there was nothing to straighten the bed with. I quickly dashed out to get a little history from anyone who knew the patient or had managed him. I wanted to know, if there was any reason he could not be turned on to his left side- I was scared of exacerbating a fracture or worse still a spinal injury.
The first few people I ran into knew nothing about him- the whole place was full of patients and there were very few casualty officers and only 2 nurses attending to everyone. I finally found someone who knew him a little. He said there was nothing to fear from putting him into the left lateral position. Next, I had to find suction to clear out his secretions from his airways. The first nurse I asked was visibly busy. She was the one attending to new cases. The other one was on the ward, attending to those already admitted. I ran back towards the ward. I asked the ward nurse for a suction machine. She was already on tenterhooks, overwhelmed by the sheer number of patients. She gestured to somewhere. I quickly ran there and started lugging the suction machine to patient’s bedside. On getting there, there were no more chest movements. One doctor shouted to commence CPR. I was already on top of it. I asked him to connect the suction machine and clear the airways while I was doing the chest compression. He did. Voila- suction machine was not working. It didn’t even come on.
My arms went weak. I looked at his face. Cyanosis is difficult to assess in black people, but I’d never seen anyone so blue- at least anyone’s tongue. It was the height of irony that someone choked to death while his oxygen was still running. I kept at the CPR, each downward thrust shot an angry bullet through my heart. My arms had tensed up and it was not just from the lactic acid. I could literally taste the bile in my throat. I bit my tongue repeatedly to keep from screaming expletives, but even my teeth couldn’t dam the words. I was angry! The other doctor looked at me and said: “his pupils are fixed and dilated.” We both knew what that meant- further CPR was useless, even if somehow, we could kick-start his breathing and pulse, he would be severely neurologically damaged.
I was angry! Angry at myself, because I could have just flipped him over to his left and damned the consequences, before going to inquire further or look for suction. I was angry at the casualty officers who had not noticed it first when he wasn’t breathing fine, angry at them for wasting my time, valuable time, with their not knowing, when I was asking questions about him. I was angry at the nurses for being so busy. Couldn’t they see there was a life that needed saving? I was furious. The brothers’ sobs had turned to wails now. Their plaintive voices were a fitting score for the scenes of destruction playing in my head. I ground my teeth until I was sure they would actually crack from the pressure, then I ground them some more. I was just furious.
Could I really blame myself? Just turning him over without checking for the things i had checked was downright dangerous. It would go against every thing I learned- to be careful, to first, do no harm. I couldn’t possibly clear his airways without suction, I was right to look for suction. I couldn’t really be angry at the casualty officers too. They had between them, nothing less than 20 patients already in, and many more streaming in through the doors. I could only be grateful to the one who had taken a little time to speak with me. The nurses. Really? What fault of theirs was it that they were severely short- handed? What fault of theirs that the beds were faulty? How was it their fault that the suction machines were not working? Still I was furious. Furious at a system that bred and tolerated so much inefficiency. We were already all bending over backwards, pushing the boundaries of improvisation to keep the semblance of a hospital running. There is almost nothing that is readily available when needed, so finding a ready substitute was a skill that was not just fashionable, but indispensable. But in this case, the limits of improvisation and substitution had been reached. The system had to either save this young man or he would die, as many others had done before him and many more would do after him.
Maybe, it is just me, but there is something about somebody dying beneath your fingers, that makes you snap, especially when you feel helplessness close around you like a body suit. Many people die here. True, we cannot save everybody, but there are those that we can but we don’t, simply because we are held back by a system that is grinding everything in its path to a halt. And this is the part that pisses me off to no end. Of course, being as angry as I was, I was rude to colleagues and patients for most of the rest of the day. It was not right, it was inexcusable even, especially when I consider that I usually go out of my way to ensure that I don’t make people pay for my or other’s mistakes.
However, in a way, I am happy that I am this angry, not because anger is a good thing, but because I am happy that I still have the capacity to feel anger at something like this. In recent times, I have been flooded with more death than I have ever encountered before in my life and I have begun to wonder if I was not growing indifferent. These patients of mine were also people- fathers, mothers, husbands, wives, children, lovers to someone who would be crushed beyond relief to lose them. I was relieved that I could elaborate such a visceral reaction, a knee- jerk of sorts to such injustice.
I don’t like it when I get angry, but may such things never fail to make me angry. The day that I can stand something like this and not boil over in fury- that is the day I have outlived my usefulness in this field.