When doctors pass the buck: The ugly side of a shift-work mentality

When doctors pass the buck: The ugly side of a shift-work mentality

“I’m just the night doc,” you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was “just the patient,” who lay suffering hours before her death and the RN was “just the nurse” withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to manage me when I asked her to give my sister a touch of morphine; she was crying out in pain from her hypoxia.

A civilized, yet ridiculous argument ensued about the dangers of respiratory depression in a patient who was clearly dying. You and I, physicians and colleagues, were arguing over 2 mg of morphine when you said, “I’m just the night doc.” I’m still shaking my head over the absurdity. Instead of assessing the situation you felt the need to pass the buck until morning. Does no one die on your watch? You were so busy, not being a physician, that you must have missed the oxygen saturation in the 70s and the flipped T waves predicting my sister’s imminent demise.

The life and death stakes were not high, the end result would have been the same. We both knew that, so why did you feel the need to distance yourself from your decision to withhold medication with a just statement? “I’m just” means that you are under no obligation to act. You were telling me in essence that you were a just an overnight placeholder in the ICU. When we are just doctors we are not our best selves.

A more honest, although equally lame statement would have been, “It’s not my job.” However, that declaration begs the questions as to whose job is it to orchestrate patient care after dark? Having been a doctor for three decades, I can’t remember a time when my obligation to care for patients stopped at dusk. That implies that patients can only expect our best selves in the daylight hours. Did I miss the memo, has medicine gone so far away from patient care that this shift work mentality is the norm or were you “just an ass”? What if you’re only a Wednesday doctor, but you’re working on Friday, will you wait until Wednesday to treat? The absurdity boggles my mind.

I don’t blame you for my sister’s death, everyone knew she was dying. She had asked for resuscitation measures to be stopped. However, in saying I don’t want extraordinary measures she never said, “I welcome a painful, oxygen starved, horrible death.” I had promised to be there with her, and I had explained the likely outcome. She trusted me to watch over her as a sister, not as a physician and I couldn’t do it. My real anger is directed inward, and I can’t forgive myself for leaving the hospital. I let you drive me away in the last few hours of my sister’s life, because I was angry and powerless. I couldn’t “just be a sister.”

Every one of us as health care professionals that night had a duty to care and we all failed due to our individual arrogance. I used your lack of compassion as my excuse to avoid facing the last three hours of her life.

We wear many hats as physicians but can we ever just be family members? The family relies on us, to translate complex medical speak, to help them understand the big picture and to act as liaisons with other healthcare providers. We usually do this willingly and in my experience, it unfortunately also allows us to keep our distance from our own very painful human experiences. I know that I am much stronger in a medical crisis when I am in “doctor mode.” You, the night doc and the night nurse wouldn’t let me be a doctor that night, thus the power struggle at the bedside. I would love to give you credit for urging me be the sister instead of the doctor, a much healthier way to grieve, but that wasn’t your intent. You made it clear that there would be no team decisions despite the fact that I had been there all night, knew my sister’s wishes intimately and had watched her oxygen saturation plummet and the T waves dip.

If I hadn’t been a doc, would you have been more compassionate towards my family? Were you practicing defensive medicine because I was there? Who better to understand compassionate palliative medicine than me, your senior colleague?

As we kept our distance from death, by arguing a moot point, my middle sister ignored us and kept her promise to my dying sister. She prayed, “Hail Mary, full of grace” softly in my sister’s ear, a comfort to both of these women of faith. She did not distance herself; she immersed herself in the process of helping another die. If we had set our collective arrogance aside perhaps we could have acted as a team and stayed in the moment with a suffering fellow human being. Patients are never just patients; my sister was a vibrant and brave mother, sister, wife, and friend. All of us failed to recognize what a profound privilege it would have been to assist another to die with dignity and grace. None of us were there three hours later when my sister passed away with a team that included a kind nurse, a compassion physician, and my sister with faith. I can’t forgive either of us for being “just doctors,” there’s no dignity in that.

Tracey Delaplain is an obstetrician-gynecologist who blogs at What’s for dinner, Doc?

Over the years, I have found myself in similar situations with Mother, Father-in-law, Mother-in-law and wife. Some end of life issues, others just poor/inept care being provided or lack of care being provided.  Depending on my perception of the severity of the violation of what is the standard of care… depends on how I approach the offending healthcare provider..  If it is rather minor infraction, I will try to muster up my “most diplomatic approach”… depending on their response determines if I drop directly into my “take no prisoners mode”… after running my own pharmacy for 20 yrs.. I  still have this “boss demeanor ” that I can bring to the forefront at a moment’s notice.  I have been known to – on occasion –  piss off hospital nursing staff… for not doing their job… at least at that point I know that I have got their attention.  Typically, things change.. in the right direction… it is gratifying to know that my loved ones are getting the medical attention that they need/deserve.

3 Responses

  1. I’m a high school teacher and can put the fear of god into the biggest football player with just a look.

    It didn’t help at all when I was in the hospital and developed a rare and very serious complication: cauda equina syndrome. No one cared even though I listed every red flag symptom in the book. The surgeon told me to not worry, it’s all perfectly normal and that I should smile so I’d look pretty. I guess I wasn’t pretty enough for him to bother with me because he did nothing for almost four days before I had emergency surgery but by then it was too late and they left me with permanent nerve damage. When I complained about not being able to even walk normally anymore he shrugged and told me that well you can still go shopping.

    Needless to say, I’m a woman since no doctor on the face of the earth would ever speak to a man the way I’m spoken to by doctors including, I’m sad to say, female doctors.

  2. I smphathize with this writer. I have been a care-giver for a lot of family members up until the end of life. From 1995-2009 with no problems with giving pain relief. With my brother in law a bottle of morphine was left with us at his home for the three month’s we cared for him until he passed.(1995)All the other’s were made comfortable.
    Fast forward to me care-giving for my disabled husband He fell and broke his hip that had six same-knee surgeries in seven year’s.(2008-2014)The three month’s he spent in the hospital I had to advocated for pain relief several times with his doctors. He still is not better as he’s using the walker from the fall. His pain management is afraid to properly relieve his pain. It’s a catch 22. These new regulations have unfortuanely affected all. It’s sad to see especially palliative care.
    Don’t stop advocating!

  3. We went thru the same thing w/my parents,,Which I took care of for 15 years,,First my father w/P.O.E.M.S.,,,,thank goodness,then my Ma was still alive to help out,,But we caught numerous errors,,,wrong milligrams of hepron,,wrong name,,,etc,,,aweful,,W/my Ma it was worse,,had x-family members,,who wanted her locked up in some nursing home to take what little money she had,,She wanted nothing to do w/nursing homes,,But same thing,,,wrong dosages,,not helping her eat etc,,,Sooo agreed now a days,,,your parents NEED some-one there 24/7 to watch out for them whilst there in the hospitals for sure,,,,or at lest a hidden nanny cam if u can’t be there,,,jmo,,,maryw

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