‘Are you excited?’ asked my roommate/ bestie Sahana as we were getting ready for the Hospital that cold wintry morning in December. It was my 1st day of OBG (Obstetrics and Gynaecology) posting and she was to begin her minor postings that day. She knew that though OBG was one of my least favourite subjects, I was actually excited about doing the rotation in the city’s Government Hospital. It had always been my fervent hope to do all my major clinical postings of Internship in that Hospital as the case load is huge there and any Doctor can tell you that the more cases you see the better Doctor you will be.
After saying goodbye to her at the Hospital gate, I proceeded towards the OBG department. Now, for anyone who’s unfamiliar with the setting, there’s an iron gate separating the OPD rooms from the wards, another gate separating the wards from the Labour room. The corridor in front of the wards lead towards the NICU which in turn is separated from the outside by another iron gate, another corridor in front of the middle ward lead towards a set of closed doors which open to the OT and all gates have guards.
I had reached 10 minutes before the reporting time and was waiting for my co-interns when I was greeted by my classmate who had done her rotation at the same Hospital previously. When I asked her about her experience, various emotions fluttered across her face but she just said that she was glad that it was over. Not a good sign when you are about to start the same rotation. She took her leave when my co-interns arrived and the 3 of us proceeded towards the wards where we were to report to our PG (Post graduate).
As we entered the ward we saw that there were 8-10 beds lined against the walls on either side with patients lying in most of them and there was a lone PG checking the post operative dressing of the patients. She looked up as we entered, asked if we were the new interns and assigned us our duties. No names asked, none was volunteered. As me and my co-intern stood there listening to her instructions, there was a flurry of activity at the door as the Unit Chief, Senior Professors and Senior PGs entered the room. Apparently, they were just finishing their rounds having started from Labour room and then proceeding from the ward closest to the NICU to the ward that we were in now. And from the look of shock on our junior PG’s face, it was evident that she was also not informed. Rounds are usually the time when the Professors issue instructions, ask about the investigations they had ordered the previous day and sometimes, if we are lucky, even share their knowledge acquired from years of experience that cannot be found in textbooks.
After earning not even a glance from the group, we hovered awkwardly behind them as they finished the rounds and left (as expected, because Interns are at the lowest level of the pyramid of hierarchy in the Hospital). As soon as they left, the PGs circled us like vultures and started issuing one instruction after the other. If some patients needed a repeat blood test, some had to get a scanning done, some required us to personally accompany them to the billing counter and sort out billing issues with various health schemes (something that I am not 100% sure of even now). Now, as that was a Government Hospital it was expected beforehand that it was gonna be crazy but what I wasn’t expecting were the demeaning remarks from them. One PG commented that I didn’t ‘look’ capable of drawing the blood (didn’t know that one had to look a certain way to show that they can draw blood!), another asked me brazenly if my brain could handle getting the billing issues sorted out quickly and the senior most PG shouted at us as to why we were still standing there (Umm, Hello, you expect us to walk away when you are giving instructions to us?).
After we finished our assigned jobs, me and my co-intern were standing near the table where the PGs were finishing up some work when we overheard them passing some snide and rude comments about the appearance of my co-intern. Tears welled up in her eyes as she did her best to not breakdown in front of them. After such a harrowing day, when I reached my hostel room, I immediately gave a detailed account to my bestie, who in turn had horror stories of her own. Since OBG was her 1st posting, she had to learn new things like drawing patient’s blood in that posting itself, a stressful situation as speed is especially of the essence there due to the sheer load of the patients. It’s like learning to drive and then competing in a F1 race on the same day!
After that, for 1 1/2 months we were ridiculed and shouted at in front of the patients, our integrities were questioned in front of patients’ attenders, our appearance and dressing style was made fun of, basically we were the punching bags for them to let out all their frustrations on. And this was not just the case with us interns, the PGs who mocked us in turn got a similar treatment by the Professors, it’s hard to believe but we actually felt sorry for them!
I hate to admit but I was also influenced by this toxic environment.
One time, after a very busy and tiring night duty, just as the dawn was breaking, I was instructed to administer per rectal Misoprostol to one patient in the ward to prevent post partum hemorrhage (as someone had forgotten to do so in the Labour room). Now, in a Government Hospital, privacy is not valued as much as it should be. With the patient’s mother holding the rug as a screen, just as I was about to administer the drug, I noticed 3 men entering the ward with happiness and eagerness etched on their faces in anticipation of meeting their family’s newborn. I shouted at them, berating them as to how they could enter the ward just like that without a care for the privacy of the patients and harshly told them to leave. After they left and I finished my job, the sudden realization as to how I had behaved so harshly hit me like a truck and shame washed over me. I was exhibiting the very nature against which I had complained all this time. The people on whom I had shouted were innocent villagers with no idea as to what was going on inside the ward and I had ruined their day and their visit. There was no excuse for my behaviour. There is no way I can justify taking out all my frustration on others. Even today, I feel ashamed when I think back on that incident.
Fortunately, there were a few good PGs in the department especially in the Labour room (the most stressful place of all) who proved that you could be encouraging, kind and basically be good to others no matter the stressful situation. Immersed as I was in that toxic work environment, I had conveniently forgotten about my very 1st Internship posting where a Senior Surgery PG had set us examples of an excellent Doctor-patient relationship day in and day out and was always kind and encouraging to her juniors no matter the pressure. I was posted in a unit which had OPDs on Monday, the most hectic day of all. Though the Surgery OPD on Monday resembled a Village fair, I had never seen her taking out her frustrations on patients, in fact the patients loved her. I am not saying that one department is bad and the other is good, there are people of all kinds in both the departments. I am just saying that it’s possible to not act like Bhallaladeva towards your colleagues, you have the choice to be like Amarendra Baahubali too!
Right from the 1st day of Medical school we are warned by our seniors that we are going to get insulted, humiliated and ridiculed but we have to make sure that we don’t raise our voices. We are advised to grow our skin as thick as a Rhinoceros.
I remember a girl in my class who was singled out and asked questions on topics that were not yet taught, humiliated in front of the whole class and made to leave just because the teacher saw that she was a few seconds late in standing up to greet him as he entered the class. If you asked questions in class, then you are marked for death! because the teacher to whom the questions were asked would make sure to single you out at every opportunity in lab/class and give sneering expression if you fail to answer the question. So, there always was a pin drop silence whenever the teacher asked ‘Any Questions?’ at the end of the class. And what’s shocking is that this scenario was there in Hospitals and Medical colleges even during the time when my Dad did his MBBS. I recall him telling me that there was a particularly notorious Professor in his college who was so feared that the students would climb the walls or jump into bushes (prickly bushes, no care!) just to get out of his path, because apparently he was failing any student who dared to pass by him in the corridor!
If a person involved in such toxic behaviour is asked as to why they behave so, the most common answer would be ‘That’s how my seniors behaved with me, grow some thick skin’. And for them I would like to say, ‘No, that doesn’t justify your actions, in fact it should make you take extra efforts to ensure that you don’t treat others the same way‘. This ‘demeaning and belittling others culture‘ is prevalent in many fields but in nowhere is it as close to the scale as it is in Medical field. I am sure that all of us have experienced this at least once and so it’s a humble request from me that at least from our generation, let’s break away from this culture and vow to be kind, generous and most importantly to be respectful towards our patients and our colleagues!