Doctors, the world over, are reeling. The global telegraph has been alight with conversations, most of them uncomprehending, shocked, dismayed, fearful. In several swift and definitive decisions, a UK paediatric trainee, Dr Hadiza Bawa-Garba was not only erased from the GMC register, but charged with manslaughter. This was in response to several medical errors – most of them oversights when the details are examined – which contributed to the death of a child in hospital. I have no intention of going through the case here, which has been expertly picked over by a good many sources. Suffice to say that Hadiza was slung to the lions, the consultant in charge leaving her naked, her hospital, her trust, the regulatory bodies entrusted with safety of both doctors and patients, all turning their backs to leave her to her professional demise. All for several decisions made when she was covering extra shifts, in a climate of heinous understaffing, and trying to manage a deluge of patients when she had just that day returned from maternity leave, unsupported and abandoned to her fate.
So much is baffling about this case and its horrific outcome. Nobody wants a child dead from misadventure. It is tragic beyond the reckoning. But for the regulatory bodies to kick back with the tendon strike and sacrifice an individual so? Is Hadiza supposed to be an example, like a spiked head at the entrance to the Thames? Unquestionably these decisions will serve to endanger patient safety in the future. Individual blame always does this, driving self-reflection and honesty underground.
Hospital systems are almost incomprehensibly complex. Patient safety is paramount, but the infinite interactions that occur within them will likely always outfox the desire to provide foolproof polices and structures. You can’t legislate for the illimitable.
The outcome of this case is extreme, but so many of the occurrences are commonplace. Without any desire to misappropriate a worthy movement, is this another instance of #MeToo?
We inside the beast are always going to make mistakes. Always. Most of them are small; oversights, errors of judgment, succumbing to biases, betrayal by the impossible circumstances in which we sometimes work. Most picked up by the lumbering checks and balances designed to avoid them.
No doctor ever wants to make mistakes. In fact, cheered on by cases like Hadiza’s, we, and the world we serve, see medical error as utterly unforgiveable, a deep personal failing. Doctors, for many reasons, are not very good at failing. I know what it feels like. I expect my experience is nothing special, but I know what it’s like to wake repeatedly in the early hours, my gut twisted and writhing re-asking myself why I thought a certain thing, or missed another. I know what it’s like to hide in the department toilets, trembling and wiping away unstoppable tears. I am on intimate terms with disgust. I know what it’s like to think, perhaps if I end it all… I know what it’s like to stopper in the shame and humiliation that comes with the perception of not being good enough. Mostly our punishment is a deafening, roaring monster within ourselves. And, if we are very, very lucky, we get a system that allows us to self-reflect, even better with some empathetic human support, and even better a respectful, inclusive way to analyse the system errors, which, almost always, are more contributory to any error than the part the individual played.
I’ve thought a great deal about the consequences of medical error. I wrote a novel about it. It’s the core of Dustfall. If perhaps a handful of people read the book, either medical, or not, and see into the heart of a doctor after failing a patient, then perhaps the six years of sentence struggling will be worth it.
Dustfall. I’m with you, it’s an odd word. It is, however, the title of my first novel, and somewhere within it is the semblance of sense.
Dustfall is a book 6 years in the making. Its release date is February 2018, and it’s being published by UWA Publishing, a cracker of an independent press who produce quality books of both non-fiction and literary fiction flavour.
When I was an intern (let us not lower the tone of this post by mentioning the year), I was flung out to Port Hedland Hospital for a term (my second only as doctor, the first being ten weeks in psychiatry), during which I was occasionally rostered on to staff the Emergency Department, alone, overnight. As you will easily imagine, this was a rather formative period for me. Frankly terrifying doesn’t begin to encapsulate it. Several times during this stint, searching for solace, I travelled round the surrounding countryside – that parched, red, horizonless outback of ours. On one of these occasions, I ended up in Wittenoom, a crumbling, soon to be ghost town. Amongst the shadows and the ruins, I came across the abandoned Wittenoom Hospital, and wandered through its shell, its broken corridors, its clanging, destroyed rooms. It was like the Mary Celeste – looking as though it had been abandoned in a hurry, with no one set to come back. Gauze rolled through the corridors, waterlogged piles of journals sat off to one side, and an old anaesthetic machine, a strangely shiny relic, gleamed in the corner. This image has stayed with me for decades, and I always knew there was a story to be had there.
Of course, Dustfall is a work of fiction, but it explores the crashing consequences of a doctor’s single mistake, as well as shining a light on a heinous chapter in Western Australia’s mining history.
More than this, I won’t say for the moment. Over the next six months, leading up to release date, there will be lots of news and numerous updates, most of which will find their way here.
It’s been a journey of wonder, writing the manuscript. A personal campaign of learning, of failure and rejection, and the rediscovery of the immense power and sublime beauty of the written word.