Inefficiency resulting from rotten systems have always been my breaking point. Every time I encounter such problems, especially when such problems could have been easily avoided if certain practices are changed always make me lose my temper. That's one of the reasons why I hated my job last year, and one of the major reasons why I eventually decided to resign. That's the same reason why I may also decide to give up one of my jobs now.
I've ranted about how frustrating it is to work at the local hospital where I'm working now. In a span of a few weeks, things have gotten from bad to worse. Truth is, things have become incredibly pathetic. More laboratory exams that are essential for treatment are unavailable. We have to send blood specimens out to other hospitals and wait for results. Waiting often takes hours, which defeats the essence of emergency treatment. We don't even have means of measuring blood sugar levels anymore. We don't even have CBG strips! It was bad enough when the management made that smart decision that only laboratory personnel can use those CBG machines. CBG machines are essential for emergency treatment--- I have yet to hear of any other hospital wherein there's no CBG machine in the emergency room! Can you imagine having to wait for the lab personnel who is often busy extracting blood somewhere else in the hospital, when we could have already gotten the blood glucose level and administered the proper treatment in less than half the time if only CBG machines were available? On my previous tour of duty, they ran out of CBG strips! Diabetic patients in ketoacidosis were told to transfer to other hospitals because we couldn't do anything... we couldn't even stabilize their condition. Trauma patients have to be transferred because we don't even have the needs to dress their wounds. There are no sedatives to treat patients with frank seizures. There's an emergency cart, but it's mostly empty. The simple task of intubation can become next to impossible. They should just close the whole emergency department because we're not capable of treating any emergency case!
And as always, dealing with the department of obstetrics is the the most problematic. I still can't figure out why obstetric patients have to be managed in the emergency room, when in other hospitals, they go straight to the labor room, or they have a separate emergency room for ob-gyne patients! One patient came in at around 1 PM with a retained placenta. She gave birth at home at around 9 AM courtesy of a midwife, yet the family decided to bring her to a hospital four hours later when she was already hypotensive and gasping from all the blood loss. We couldn't just pull the placenta out without an emergency set up because it could result to more bleeding. To be safe, she should be managed by an obstretrician in the operating room. To complicate matters, she's a Jehovah's Witness--- you know, those people who would rather die than to undergo blood transfusion, because that's what their belief tells them. Good thing I'm an agnostic and therefore free from such religious stupidity and bullshit...So we had no choice but to keep on administering intravenous fluids to keep her blood pressure up. She was referred to the obstretrician on deck, who refused managing the patient because there was no room available and she did not have enough money to buy the required needs for operation. She told us to transfer the patient, which of course was out of the question since the patient was still unstable. More relatives came, they eventually got enough money, and they managed to get a room. So she was referred again. Then the consultant said she still can't accept the patient because the procedure (possible hysterectomy) cannot be done there because she MIGHT need certain instruments that MIGHT be unavailable . WTF?! It would have been easier to understand if she just told us outright that she was simply lazy and didn't want to go to the hospital on a Sunday afternoon!
When the patient's vital signs were a bit stable, we tried calling other hospitals that would accept her. As expected, no hospital would accept a hypotensive patient for transfer, especially if she is a Jehovah's fuckin' Witness and therefore CANNOT undergo transfusion. Last year, I had a patient with the same beliefs before, and I couldn't help but shout at all the relatives out of frustration. I shouted at them for being so stupid, for letting religious beliefs, teachings that someone else just handed out to them, cloud their common sense. I was torn between my duty to save a person's life and respecting their stupid religious beliefs. In the end I gave up. There's no use trying to save people who refuse to save themselves.
The Obgyne residents, most of whom are overflowing with pride and think they're superior to everyone else because they have finished residency training but still take jobs as residents because they have no private practice, are not making things easier. Is it too much trouble to go down and assess the patient, help us in their management when all they do upstairs is sleep? Where's that post graduate training that they're so proud of? As if Obstetrics is such a difficult field to specialize in. They keep on doing the same things again and again, it's actually considered a no brainer in the field of medicine. If we exchanged places with them, I bet we would have an easier job delivering those babies even without residency training, and I'm sure they wouldn't know what to do with all the patients coming in with heart attacks and brain hemorrhages. It took a call from the hospital director to get things done. They were probably afraid of the media frenzy that such a case would result to, because how the case was being managed was very unethical. After more than 6 hours, the patient was finally brought up to the labor room. The patient could be admitted after all, why did it have to take that long? Is it because the patient wasn't rich, and the consultant won't be getting a high professional fee for her services? Or was she simply lazy, and no monetary benefit could make her move that lazy ass of hers?
That wasn't the only problem we had with their department. After a few hours, a patient in preterm labor came in. There was no incubator available, so we advised her to transfer to another hospital. Then she came back after a few hours, because a consultant told her to go back because there was no other hospital that would admit her. She would just sign a waiver saying that she knows the consequences of preterm delivery without an incubator available. About the same time, another patient came in with admitting orders, she just had to complete the needs required. We informed both consultants that there was no room available. They said to just bring both patients to the labor room while they wait for an available room. That seemed simple enough--- BUT the hospital had this policy of not admitting patients if there's no room available, unless those pregnant patients came in with a fully dilated cervix, and therefore giving birth is imminent. So the charge nurse in the labor room refused to have the patients transferred from the ER, even when they already bought all the required supplies, even if the consultants were informed that there was no room available. They said that the patients should just return the things they bought and transfer to another hospital. Jesus Christ. One of those patients was already advised to transfer to another hospital. She was told to come back, only to be told to transfer again?! Was that some sort of joke? Did they think it was some sort of game? Good thing her consultant advised her to wait at the ER even though the environment is very unsterile. The other consultant told me to tell his patient to transfer. After monitoring her pregnancy regularly for months, he just decides to turn the patient away? Shouldn't he fight for his patient? Who cares if it's the hospital's policy not to bring up patients who are not yet admitted to the labor room? If for whatever reason he can't transfer the patient to another hospital where he's affiliated with--- He's a fuckin' consultant, he should find a way! A dictator didn't make those rules, those rules are not absolute and can therefore be bended! Instead he didn't even fight for his patient, he just agreed to what the charge nurse said. Jesus, that's the first time I've heard of a consultant who bowed down to the powers of a charge nurse.
I got really mad. I kept on shouting expletives. I was ready to punch that charge nurse in the face. There were empty beds in the labor room! If the patients were about to give birth, they would allow them inside the labor room anyway, even when they had no room available! What's the difference?! --- So what did I do? I didn't tell the patient to transfer. No way. I told her to wait, because when she's about to give birth, the have no choice but to admit her. i told her to file a lawsuit if she can. I told her to tell the media. I told her to tell the whole world about the great hospital she's in. Then maybe that would result to change. If they can't change, then maybe they might shut down the whole hospital. Frankly, I don't really care if that happens. A lot of people will lose their jobs, but those who are good at what they do can easily find work elsewhere. A hospital that is that fucked up shouldn't even be open in the first place.
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