Thursday, June 20, 2024


Dhaka Tribune

Down the rabbit hole

Update : 20 Nov 2015, 06:02 PM

 “Didn’t you realise that your father had lost so much blood?” A nurse directed this question at me as I struggled to come to terms with the lifelessness of my father’s body at the ICU. For several weeks after my father’s funeral, I couldn’t stop myself from thinking about this question and reliving our experience at the hospital.

My father had been admitted to the hospital at 1pm on April 14 with dangerously low blood pressure and abdominal pain. For 20 hours, he received gentle and then aggressive medications to raise his blood pressure.

At 9am the following day, several doctors came to see him and the underlying cause of this low blood pressure was finally diagnosed: Gastric bleeding. Doctors asked me to arrange for 10 bags of blood. Four hours later, he went into cardiac arrest, and doctors were unable to resuscitate him.

The nurse’s question had taken me aback, but I only responded with a simple “no” as I tried to focus on my father. I was struggling to absorb what had happened. My father had laughed and chatted with me from that very same bed just a few hours earlier. Now, I somehow had to accept that that interaction had been our last.

I wish I had asked the nurse why doctors and nurses hadn’t used the first 20 hours after my father was hospitalised to diagnose the underlying cause of his low blood pressure.

I wish I had asked the nurse why the hospital considers Pohela Boishakh an off day. I wish I had asked the nurse why doctors had put my father on aggressive blood pressure raising medications without considering whether this might fatally worsen the underlying problem. I wish I had told the nurse that a cousin of mine had suspected internal bleeding, and that I had sent a note to the ICU at 1am informing the duty doctor that my father had a history of internal bleeding. The doctor who called me 14 hours after my father was admitted told me my father’s case was not an emergency.

I confess, I felt angry with the nurse, because the question seemed cruel and inappropriate at a time when I craved compassion. But of course, I am angrier with myself.

I’m angry with myself for being so grateful that a doctor had called me at 3am with an update that I didn’t insist that my father’s case was an emergency. I should have insisted that a CT scan or at least an ultrasound of the abdomen be done then, in the middle of the night, and that a consultant be called in to interpret the report.

I didn’t want to play the role of the interfering, entitled attendant, but now I can’t help but wonder whether that interference could have saved me incalculable guilt and regret.

I’m angry with myself for trusting the doctor when she said my father’s case wasn’t an emergency.

I’m angry with myself for wanting to believe that my father’s case wasn’t an emergency -- I craved reassurance, the doctor gave it to me, and I went to sleep while my father continued to hemorrhage, under-investigated and undiagnosed, in the ICU.

I’m angry with myself for trying to censor my father when I went to see him on the morning of the 15th just a few hours before a cardiac arrest would take him away from me. He had said, "Look at them [the doctors and nurses] rushing around now after doing nothing yesterday. What happens to patients with no connections?"

My father’s words alarmed me and I silenced him. I didn’t want the doctors to feel offended. We were in a vulnerable position. My father was in their care, and we had already learned that connections are not a sufficient condition for proper care. In a way, doctors had decided to be fairly egalitarian in their negligence of patients on Pohela Boishakh.

I’m angry with myself for being terrified, and rushing out of the ICU when I caught a glimpse of aggressive CPR being administered to my father. I wish I had had the strength to stay as close to my father as possible. In the ICU waiting room, I forced myself to stay calm and collected in the ICU waiting room to avoid alarming my mother as I silently begged God not to take my father away from us. “They’re taking care of him,” I kept telling her.

The nurse’s question stung, because I wish more than anything that I had known for sure that my father had a hemorrhage, so that we could have gotten him a potentially life-saving blood transfusion earlier. I wish I had insisted that the doctors investigate my cousin’s suspicion that my father had abdominal bleeding. I wish I had been a better advocate for my father.

In the end, doctors said Allah’r hukum. Everything is God’s command. But religion also has provisions for accountability (otherwise there would be no penalties for crimes) in this life as well as the next.

In the fog of our grief, we didn’t ask doctors for a clear explanation of what had triggered the cardiac arrest and no one offered one to us.

My sisters and I were left with countless questions about what had happened, and we didn’t know whether we would have the strength to go and press for an explanation. Amidst all the cases they handle, would the doctors even remember my father, who was our world but just another patient to them? Would they have the records necessary to piece together some explanation?

I wrote up a set of recommendations based on our experience and shared them with the CEO, Director of Clinical Services, and owners of the hospital. I didn’t expect anything to change in the near future, but I wanted to channel my anger and grief into an effort to raise awareness about medical negligence.

Attendants should be able to seek and receive explanations about treatment options and risks, rather than being rushed to sign whatever forms are presented to them. They have to give doctors and nurses the space to do their work, while serving as advocates for their loved ones. 

We need to work towards a health care system in which hospital staff serve as advocates for patients, so that attendants don’t feel the urge to interfere and oversee their loved ones’ treatment and thereby expose themselves to accusations of interference.

There are too many accounts of medical negligence to allow attendants to completely place their trust in hospitals in the absence of adequate and effective mechanisms of quality control.

Three months after my father had passed away, I ran into the doctor under whose care my father had been admitted. I introduced myself and asked him for clarification about why my father had gone into cardiac arrest.

“He had lost too much blood and gone into hypovolemic shock,” the doctor said after expressing his condolences.

I asked him why my father’s complaint about abdominal pain at the time of admission hadn’t pushed doctors to consider the possibility of gastric bleeding or an aortic aneurysm much earlier.

“He was a heart patient, so we focused on monitoring his heart and didn’t give importance to his complaint about abdominal pain,” the doctor responded.

He encouraged me to come and speak to him if I wanted to discuss this further.

“We’re not the type to hide whenever we see a patient’s relative,” he assured me.

The responsibility for medical negligence does not lie with individual doctors and nurses. There are structural problems that impede the development of mutual respect, professionalism, and accountability in our health care system.

The question my father asked a few hours before his death continues to haunt me: “What happens to patients with no connections?” Are such patients able to get timely treatment? Do they receive adequate information about their treatment options and associated risks? Are the bereaved able to get explanations and answers in the wake of their losses?

I don’t know what it will take for hospital administrators and staff to systematically respect patients and their families, listen to patients carefully, provide holistic diagnoses, engage in professional behaviour, and be accountable to every single patient, irrespective of status.

Skilled doctors are in high demand and given concerns about inter-hospital poaching and brain drain, it is challenging for hospital administrators to develop mechanisms that effectively promote accountability.

Doctors committed to patient rights and accountability have a pivotal role to play in making health care in Bangladesh more patient-friendly in spite of challenges related to resource constraints and patient volume. 

The power imbalance between doctors and patients is one that brings some of the most powerful people in our country to their knees, regardless of the resources and connections at their disposal. We can only hope that as they rise up from their losses, they will raise others up with them by advocating for a health care system based on mutual respect, professionalism, and accountability.

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