Medicine’s dark side: drowning in shame

TAUREEF MOHAMMED

IT WAS my first ever overnight shift in the intensive care unit, and – as it is at the start of every new placement during medical training – I knew little about intensive care. A middle-aged man was brought down from the medicine ward to the ICU: he was struggling to breathe; every breath that he took looked like it could very well be his last; if we did not “take over his breathing” – as they say in the unit – he would die.

The first step to take over a patient’s breathing is intubation. It involves passing a flexible, 13-inch long, half-inch wide, plastic tube through the mouth, pass the vocal cords, into the trachea, which, if you think of the lungs as a tree, is like a tree trunk. With one end in the trachea, the tube is then connected at the other end to a ventilator, the breathing machine.

The man needed to be intubated, STAT.

I was the only doctor there – my senior colleague was on her way. Nurses and a respiratory therapist (RT) had gathered around the man’s bedside. Each of them moved with precise purpose: one connecting this to that, another drawing up medication, another drawing blood, another writing. They looked like they had all done this before.

In the middle of the organised commotion, the ICU charge nurse – a very important person in any hospital – looked at me and said, “You don’t know what to do.” And I just stood there. “What meds do you want to give? You don’t know.” She answered her own question. So, again, I just stood there. To her credit, she appeared to be unfazed by the fact that I was a doctor who appeared to not know what to do. It was a teaching hospital; she had been here before.

In a matter of minutes, my senior colleague arrived at the bedside, took control of the situation, giving clear and direct instructions. The RT intubated the patient.

The man, who looked like impending death a few minutes ago, was now asleep, breathing comfortably, his chest wall rising and falling rhythmically with the whizz of the ventilator.

The crowd dispersed; the organised commotion was over.

Meanwhile, I was drowning in shame. I was in Yusuf/Cat Stevens' Novim’s Nightmare: “Who would know if I should die?/ No one needed me/ Dark and empty was the place to which I’d come.”

I struggled to understand what had just happened – it all happened so quickly. As the only doctor there, was I expected to take control of the situation, although it was my first night on call? Was I expected to intubate the patient? The last time I had intubated a patient was four years ago. I was a medical student at Port-of-Spain General Hospital and the anaesthetist had held my hands – literally – through the procedure. So, I wouldn’t have felt comfortable intubating this man. Was it OK to be uncomfortable? Was I incompetent or uncomfortable? Why did the charge nurse’s words sting so much? Maybe I was just a flake.

When you are in a situation that does not make sense, your feelings never lie. And I knew what I had felt: shame. I had felt it before.

I was an intern working in paediatrics, and I had made a medication error. When my senior brought it to my attention, I started to cold sweat – shame was seeping out. The senior doctor empathised with me. Maybe he had made a similar mistake in the past.

As a medical student, I had witnessed shaming at a departmental educational meeting. In a packed room – full of medical students and doctors – two consultant doctors, like vicious lawyers cross-examining a criminal suspect, shamed a couple of junior doctors who were presenting – on behalf of their team – a case of a medical error. In a hysterical fit, one of the consultants said:

“What if the media got hold of this?” The public image of the hospital was more important to the consultant than the junior doctors’ self-esteem and mental health. What a bloody shame!

So, over the last decade – through medical school, internship, specialty training – shame has been a constant. Perhaps, as one moves up the ladder, one feels it less.

To healthcare professionals who are at the top of the ladder: don’t waterboard those below you. Many junior doctors struggle to keep their heads above water. If you can’t lift their heads up, for heaven’s sake, don’t push them down.

For resources on physician wellness, visit: www.cma.ca/physician-wellness-hub

If you are having thoughts of suicide, there is help available. If you are in TT, call LifelineTT at 800-5588, 866-5433, 220-3636. In Canada, call Talk Suicide Canada at 1-833-456-4566.

Taureef Mohammed is a graduate of UWI and a geriatric medicine fellow at Western University, Canada