Emergency Workshop

I have never held a workshop without prior planning, on an emergency basis. But something happened that forced me to. There was the monthly meeting of the Labor Ward committee, which we formed to sort out issues that arose in the management in the emergency room and labor ward. Two senior staff members, all lecturers and all senior residents attend this meeting along with the nurses of that area. The Sister-in-charge told in the meeting that she was quite upset with the way the Registrars spoke with the House-officers. They abused the House-officers, publicly questioning their intellect and humiliating them in front of the patients, relatives and hospital personnel. The asked them if their fathers would do the work the house-officers did not do. Then the house-officers (usually girls doing their first posts) sit in the labor ward crying. Only one Registrar was good to the juniors and civil in her behavior, she said. This behavior of the others needed to be stopped urgently. So I called the senior residents for a 15 minute workshop in the afternoon. It went on for one hour, but the extra time spent was worth it. "This workshop is on communication skills" I said. It is different from others on this topic in that it is about communication between senior and junior residents We shall began with a role-play. I need a volunteer." No one volunteered. So I selected a volunteer, and announced that she would be the Registrar while I would be the House-officer, meeting in the Labor Ward in the morning. "Now talk to me" I invited. She started and stopped. "Go on" I said. She grinned sheepishly, but wouldn't go on. So I went on myself. "Madam, I am doing IPM of this patient" I said holding an imaginary transducer in my hand against tummy of an imaginary patient. "I have not finished my morning round yet." She did not scold me. "Thak-thak-thak--thak-thak--thak-thak-" I mimicked the fetal heart sounds "thak.....thak.....thak.....thak.............thak.............thak........................thak" I slowed the fetal heart rate indicating severe fetal distress, the fetus about to die. She did not panic and say 'don't just stand their, stupid. The baby is dying. Start oxygen.' She just kept sitting there. Finally our Associate Professor intervened. She said she would be the other volunteer, and all Registrars would be the observers who would comment on the role-play afterwards. I stood up afraid of the Registrar and went through the standard dialogues like "Yes Madam, No Madam, Sorry Madam" and performed all tasks with alacrity as guided. The AP did well berating me and shouting and saying the Boss would arrive any minute and scold her for the House-officer's inefficiency. The Registrars were enjoying the show and were laughing merrily. But she did not use the right words. So I changed positions with her, making her the House-officer while I became the Registrar. Then I thundered: "Where is your intelligence, you stupid? If you won't do this work, who will do it, your father?' Suddenly there was silence all around. They recognized the words that they had been uttering so often. The AP was shocked. "I did not know they used such words" she said. "The sister-in-charge of the ward told me" I said. Then I started the discussion. "The Registrar must not be called Sir or Madam" said one. "We don't allow them". I knew they still did it and probably enjoyed it too. The AP invited them to speak on at least one traumatic experience they had had as House-officers at the hands of their Registrars. They told a couple of moving stories. Then I told the story of my Registrar preventing me from going for a breakfast and dinner half the time of my six months of residency, by making me wait for hours before starting work in the morning or evening, so that there would be no time for food afterwards. I had lost 11 kilogram of weight in that six-month period. I also told them of my Lecturer who did not want me to operate as a House-officer for reasons unknown. As per rules, the last case would not be induced after 1:00 P.M. Once there was a case for me and there was time too. But she kept putting the last few sutures very slowly, helped by the nurse who kept giving her tiny pieces of suture material. The minutes were ticking by. Finally I lost my patience and asked the nurse to give a long piece of the suture material. She also did not want me operate because it would mean another 2 hours of assisting. So she said rudely that she would give longer suture material if the Lecturer asked for it. I urged the lecturer to ask for it and she just kept quiet. I did not operate that day too. The trauma of those denials had deeply scarred me, and it hurts even today, 29 years later. The Residents looked at me with empathy. "I suffered as a House-officer" I said. "But I decided then that my House-officers would not suffer like that when I became senior. When I became a Registrar, I managed time such that all of us Residents would be able to go for breakfasts and dinner together. When I became head of a unit, I scrapped the routine of bosses operating every time and the house-officer only if there was a case left and time left. I started the system of giving every one a chance to operate in turns. I may have a lot of faults (I did not believe I had any, but then which human being thinks he has any faults?) but this was one good thing I did that I would like you to do as I did. If you have been troubled by a senior person, do not take it out on your juniors when you have the chance. Break that chain. Be good to them so that they will think that is the way things are done around here and they will be good to their juniors too." We ended the workshop on that note. They mumbled "thank you" and "Bye" etc, and went away. In the eyes of most of them I saw a promise they would do so. I hope they keep their promise.