Nothing personal!

Doctor in The Dock (2022)
Author: Ariza Mohamed 

I have known Staff Nurse (SN) Theresa since 1988. She embodies what I perceive as a true manifestation of the lady with the lamp. Though she may not be the social reformer and statistician that Florence Nightingale was or her contemporary, the flamboyant Mrs Mary Seacole, the nurse who nursed convalescing Crimean War soldiers to health, she did her own share of saving lives.

Growing up in an orphanage, Theresa felt a need to repay society. She did not see the need for a family of her own.

"The world already has enough children and enough broken families!" She commented once.

Outside her regular busy duties at the Maternity Ward of a public hospital, she managed to squeeze time for inmates of an orphanage, old folks' home and church.

Her dedication at work was exemplary, earning the best employee award many times over. She would go out of the line of duty to help her parturient patients, even teaching them the minor points about breastfeeding during the graveyard duty.

I was reminded of her while reading this book. An Obstetrician was sued for negligence 16 years after the event. The Obstetrician, the author, had seen a mother who presented in an advanced stage of labour at 26 weeks of pregnancy. The mother was in the process of being transferred to a tertiary centre that could handle premature babies when delivery ensued. The baby later developed cerebral palsy. 16 years after the delivery, the Obstetrician was sued for not suppressing labour when the mother presented at her practice. The plaintiffs' (the baby and parents) bone of contention was that delivery could have been averted or delayed if labour had been suppressed.

Four long, harrowing years later, after reaching the stage of the Court of Appeals, the doctor was relieved of her negligence. Still, the complainant was awarded the most enormous compensation in a Malaysia medical negligence case, RM 8.9 million.

The author describes her experience dealing with the bureaucracy of the legal system. The emotional and economic turmoils that the doctor endured are indescribable. Her whole life appears in front of her as a wasted one, serving, helping the needy, forgetting food and sleeping, all just to be assessed condescendingly. All her academic laurels appeared pale in her current position. Netizens, with a crystal clear vision of hindsight, were quite brutal with their opinion and caustic with their remarks. Even before the courts had set the hearing, these armchair judges, jury and executioners had already crucified the accused.

Leaving the fate of the future of a person of science to be determined by the learned who could not differentiate between ECG and CTG seems unfair. No matter what they may say about practising being an art, ultimately, it is science that decides what this or that modality of treatment is appropriate. Assessment by members of the medical fraternity is more relevant. But, in reality, are the men in robes and sharks really going up their chunk in the game of medico-legal interplay? That is bad for business.

Coming back to the case of SN Theresa. It happened during one of the nights she was on duty. A mother had just delivered a few hours previously. Theresa, after helping her out with breastfeeding and settling her with her baby, continued with other duties. A colleague saw the patient sprawled awkwardly on her bed. She alerted others, and soon, a code blue was initiated.

The patient had collapsed due to a non-obstetric reason. An aberrant splenic artery had ruptured, and she bled in her abdomen. Surgery was prompt and successful, but the patient succumbed to lung complications two weeks after the episode.

The family sued the hospital for medical negligence. During the trial, Theresa was called in to give testimony. So when the Plaintiff's lawyers inquired about the events before the collapse, Theresa narrated what actually happened. She was taken aback by what the learned lawyer had to say.

"You mean to tell me that a government hospital teaching and guiding a recently delivered mother through breastfeeding at 1.30 in the early morning, and you want me to believe that," he went on all four barrels. "I put to you that your whole nursing team neglected the patient and only discovered to be out cold."

It had come this. An armchair critic, a lawyer who makes a living out of others' misery, who taught himself medicine through the clinical practice guidelines online minus the pressure of peer assessment telling a dedicated nurse who answered her calling she must be doing her work. I do not know the trial's outcome, but as was narrated, that incident got stuck in my mind.

Seacole and Nightingale

The author left clinical practice for a teaching career. The last time I heard, Theresa had retired from Government services. She divides her time between extending her much-needed services to her private patients, orphanage and old folks home.

The era of a paternalistic attitude of the medical staff towards poor, helpless patients is long gone. A medical personnel is just a spoke in the machinery of modern society. Health is a commodified product sold to individuals who demand perfect health as an undeniable right with no margin for error. Then, a small fraction of people gain from falling sick. Sometimes, unaffected parties have nothing personal against the medical workers. They are grateful to them, but they see a lot of money, if unclaimed, going to waste, but it could come in handy to ease the pain of falling sick or being debilitated.

N.B. Florence Nightingale OM RRC DStJ was an English social reformer, statistician and the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War, in which she organised care for wounded soldiers. Mrs Mary Jane Seacole was a black 'doctress' who did her style of treating weary battle-fatigued soldiers, which involved spirits of the beverage kind. A British born in Jamaica to a Creole mother, she ran a boarding house and dabbled with herbs. In 2004, she was voted as the greatest black Briton

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