Tuesday, 23 December 2014

It's a Mother's Job to Pull Rank

Apart from boardrooms, the other places I’ve encountered a high concentration of psychologically dysfunctional individuals were, in the enclaves of Westminster and at a British Psychological Society (BPS) conference. I was invited to exhibit my research on agency v’s structural manifestations of sex discrimination within organisations. When I turned up, my pitch was facing a rear wall. When I protested that no-one would see my exhibition, I was blithely informed, “Well, it’s a bit controversial, you’ve got some pretty bold images (he was referring to actual recruitment adverts featuring testosterone charged images of men). We don’t want to alienate [male] delegates”!

Despite the initial resistance, I persuaded the organisers to take the radical move of relocating my pitch to a more prominent position. No cash exchanged hands.

At lunchtime, there was only one seat free in the dining hall. Out of politeness I asked the man opposite if I could join him. He looked at me as though I had killed his cat and stuffed it with out of date horsemeat from Tesco. Ignoring the pregnant pause, I smiled and sat down. About to take my first mouthful of chargrilled potato soup, the man said, “I was hoping to be alone”. Strange thing for someone who paid £150 to be surrounded by other people to say I thought. I assured him that a soon as another seat became available, he could be alone with someone else. In the meantime, I was comfortable with eating in complete silence. Thirty minutes later, I still didn’t know the stranger’s name but I could give you chapter and verse about his unresolved Electra complex. He was a psychologist and "an expert" (in something to do with the mind)but that didn't prevent him from being a psychological mess himself.

So when I found myself in A&E last month advocating for my 6 year old and my husband, the words “Trust me I’m a doctor” were never going to wash. Letters after your name and titles do not infallibility make. If there’s one thing I learnt hanging out with so called eminent folk, it’s that everyone is fallible and no-one should ever be beyond scrutiny. In fact, the less accountability, the greater the likelihood of error.

In this year’s BBC Radio 4 Reith lectures, US based Dr Atul Gawande, grappled with why doctors Fail. He examined how much of failure in medicine remains due to ignorance (lack of knowledge) and how much is due to ineptitude (failure to use existing knowledge). He advocates putting systems in place, such as checklists for surgical teams to go through before embarking on surgery. Despite medical practitioners railing against the system on the grounds that “we know our job, we do this every day”, those teams that followed the system reported significantly reduced errors and better surgical outcomes. In short, even experts make mistakes and cross checking can save lives.

I hadn’t heard Dr Gawande’s lecture before I got the phone call we all dread. My loved ones had been hurt and were en route to hospital. A **** came ‘round the bend on the wrong side of the road and hit my husband’s car head on. Our 6 year old child was in the back. They both sustained injuries and were hospitalised for two days. In A&E I was inwardly distressed but outwardly calm.

I never left my sons side. I asked the nurse responsible for my husband’s care to give me an update every 10 minutes. A&E is a frenetic, overwhelming environment. Not somewhere any parent wants to find themselves with their child. By way of slowing the pace down enough to allow my brain to assimilate what was happening, I asked everyone who entered the room to identify themselves to myself and my child and to explain to us what they would be doing, before doing it. I needed to feel I had a semblance of control, some level of involvement in decisions that were being made, from the start.

Fortunately, my son’s presence was like an enchantment. The staff came in their droves to meet the boy who, despite his injuries, never complained. Every-one was lovely and very tolerant of my constant questions, which were always posed in a respectful, appreciative way. Then the big cheese came in. The doctor. He was authoritative. But did he really know what he was doing? After examining my son he ordered x-rays. I asked why he didn’t order more. He explained that he’d been satisfied by his physical examination that it wasn’t necessary. “But how can you know for sure…” I challenged, politely, but earnestly, “…if you can’t see what’s happening inside”.

A junior doctor said the big cheese knew what to look for. Not moving my gaze from the big cheese himself, I said, “Then I’d be grateful if you could impart that knowledge in a way that I can understand”. To my amazement, he did. There was no hint of reproach in his tone. There was no jargon, no condescension. Just facts delivered with compassion. He explained the protocol of minimising unnecessary exposure to radiation. He knew what he was doing. I could trust him and I did. I made the usual self-deprecating apologies for being an anxious mum but he rebuked them, “You’re just doing your job, which is to make sure I’m doing mine”. You could have knocked me over with a cardboard bed pan.

Over the course of spending 2 days in an NHS hospital, my little boy was superbly well looked after. On the second night, my child was exhausted. The previous night was punctuated by intrusive, though necessary, hourly obs. By the second night, having spent the day in hospital and spoken to a number of doctors, I was looking forward to him getting more sleep. But the hourly obs continued. By 10pm, he had had 4 interruptions and was crying for sleep. Emboldened by my A&E big cheese experience, I asked the nurse (with whom I had struck up a warm rapport the previous night) to explain why my son was still on hourly obs and if the reason wasn’t medically compelling, I would like him to have an uninterrupted (as much as possible on a children’s ward) nights sleep. She explained that the instruction hadn’t been amended by the doctor. She kindly offered to confer with the on call doctor.

The doctor came on the ward and very politely told me he was down for hourly obs but couldn't help me understand why, other than, “doctors orders”. He was a very affable junior (i.e. big cheese in training) doctor who was just following orders. I didn’t want to make his life difficult but this wasn’t about him, or me, it was about my sick child. In a haze of sleep deprived angst I tried to convey my concerns. To communicate that every maternal bone in my body told me that what my child needed more than anything else right now, was a few hours of uninterrupted sleep. I argued that his body needed rest in order to heal and that being poked and prodded by beeping equipment that startled him every hour could only hinder his recovery. I told him I wanted the obs’ to stop until morning and that I would take full responsibility. I offered to put it in writing.

I pulled rank as a mother and to my amazement, it worked. Turned out the junior doctor wasn't a "big cheese in training". He was already a brilliant doctor. He possessed two qualities you can't teach in medical school. The ability to listen and compassion. He put my child's wellbeing before his career that night, and for that I'll be eternally grateful. My son had a solid 8 hours sleep and awoke rested. Ready to fight another day.

When I tucked my little boy in tonight he said he didn’t care if Father Christmas didn’t bring any toys (delayed concussion?) as long as I promised him my undivided attention on Christmas day. “No work for a whole day mum. Do you think you can do it”? “I can do better than that”, I said, “I’ll disconnect until January!” I'm sure that rabbit in the headlights look in his eyes, was an expression of sheer joy. Definitely not dread...

I’m not religious but I embrace the opportunity that Christmas affords us to wind down and reconnect with the people and things that matter. In that spirit, I wish you all fond festive greetings, wherever you are in the world.

*Had this not been such a personal story involving my role as a mother, I would have used the word “parent”. Pulling rank applies as much to fathers as mothers, in my view.

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