Thursday, November 23, 2006

the power of the ring

recently there has been turmoil in the theaters in our hospital, all caused by me. it all started about 2 months ago. i was getting ready to do some operation when i noticed the senior sister, who was training the junior sister to scrub had not removed her rings. this is absolutely against internationally accepted protocol. the reasoning is the area between the ring and the finger can't be readily accessed by the soap and therefore organisms can escape eradication there. this obviously has implications as far as sepsis and therefore post operative complications are concerned.
i, as politely as possible, informed the sister that she needs to remove her rings. she continued to scrub, basically ignoring me. i slightly less politely insisted she remove her rings. about here there was a verbal fight. i refused to back down and the rings were removed "to preserve the peace" as she stated to me. amazingly enough i was the bad guy in the story! i agreed but said if we couldn't speak about the problem here, i would have to address it later.

at the official meeting between the department of surgery and other departments including theater staff i brought it up again. theater staff came prepared. i was told that i'm infringing on their culture by demanding that they remove the rings. (this entire aspect of modern south african society i may address in a future blog) more than half of all the theater sisters officially stated they would rather resign before removing their rings to scrub.
i responded by stating that i'm not appointed to pander to their or anyone elses culture. i'm there for the patients and if they are doing something that is detrimental to the patients i couldn't care if they have a cultural or religious or other reason for doing it. they simply may not do it with my patients. if they have a problem with this i agreed they should resign.

things were left somewhat in the air. a few days later i was again scrubbing and again saw the sister hadn't removed her ring. i insisted she did. she replied that it is hospital policy that it is not necessary. i refused to allow her to scrub with me. i was given the most junior sister to scrub with me (i was doing a gastrectomy!!!). at about this stage i decided that i would make sure that i did not get dragged down into the quagmire of apathy and couldn't give a dam attitude that permeates health care in the province. i would at least make sure that my slate is clean, no matter what everyone else does. no one would scrub with me wearing a ring!!

some time later, again i was preparing to do a mastectomy on a lady that had recently undergone chemotherapy (neo adjuvant). due to the chemo her immunity was already partially compromised. the sister scrubbing was wearing a ring. i told her to remove it or remove herself. she ignored me completely. i asked my assistant if he could hear me speak and see me because maybe i'd moved into another plane of existance and she wasn't ignoring me, but genuinely couldn't see and hear me. but apparently i was still in this physical realm. i went to the hear matron of theater and complained (why should something like this be necessary?). she solved the problem be simply reassigning the sister to the other theater. she did not remove her ring. again i was given the most junior sister.

during the operation i spoke my mind, unfortunately to the converted, but none the less.
the point is we work for the state and therefore we treat the poor. we are the doctors of the lower eschelons of society. but does this give us the right to offer an inferior service? we need to decide if we are working for money only and to hell with the rest or do we really do it for the calling that medicine should be? the attitude of all the sisters who refused to relinquish the ring are giving a clear message to the population as a whole. that is we in the state hospitals will go through the motions but we don't care about you, our patients. you are the poor and the lowly. why should we care if you get sick and die? just as long as no trail of guilt can be traced back to me.

i refuse to accept this! i will not be changed by the apathy of my province! if that means i must fight every day then so be it. if i forever am given the junior sisters, then at least they will be teachable. i will not compromise what i know to be right just because we work on what society deems the dregs. i do not deem our patients less worthy that the well off and i will afford them the best i have to give!!

the other thought i had was the thought about what most peoplke think of me for staying in the state. most people have this idea the state doctors are inferior. otherwise why wouldn't they do out and make money? the truth of the matter is many doctors in the state have only limited registration to work only in the state. that means there is truth in the concept of the inferior state doctor. so when someone like me that is fully trained and fully registered stays on out of free will it is really the exception. but someone has to start somewhere to try to fix the overwhelming rot that has set into state health care. would i be justified if i critisised standing on the sidelines?? i think not.

so i will remain a state doctor and hopefully i will gradually make a small change. hopefully i will have number of big influences in individual lives. this is all i can really ask for


scalpel said...

Wow, I cannot believe that anyone would even consider wearing a ring during surgery.

Keep fighting that battle, because it is a battle worth fighting.

Anonymous said...

Just found your blog, via barb.

Well done. Can you report the nurses to the nursing council or whatever the organisation is called in SA?

Karen Little said...


This is one of those stories that is actually so sad it's funny... The irony is that those exact same sisters would pounce on you for infringing on their own protocols in the tiniest fashion.

Anonymous said...

I'm proud that you're maintaining your high principles.
Keep it up!

petunia said...

Thank you for visiting my blog...i have moved on after adopting and don't have time for as much blogging but read. I admire the work you are doing and admire that you are trying to bring health to people despite their ignorance of issues we see as obvious in this day of medical knowledge. NO ONE would think of not removing rings when scrubbing in. Too many lawsuits in the US....but what is the recourse if one of your patients dies of a staff infection? Who is to see to it this does not happen? Kudos to the doctor who will stand up to the nuns!!!!Keep iy up and don't give up....they may learn yet. Maybe can you give a little seminar??

Dr Guinevere said...

Well done for taking a stand and sticking with it. I hope 6 years after writing this post you still have the energy to insist on good patient care from the sisters.

In SA people somehow think that throwing around the word "culture" gives you free reigns to do just about anything. The president has a gazillion wives and the tax payer maintains them in the ultimate luxury because it is his "culture". No SA cultural group has a special view on rings in any case. Some African tribes wear ankle bracelets or midrif strings but I've never heard of any such group with a thing for rings. In any case, it is a WESTERN tradition to wear a wedding ring on the fourth finger of your left hand, not an African tradition.

This country PRIDES itself on having a well thought out and modern constitution. In that constitution, culture is duelly respected but, first and foremost it states that no person's action may infringe upon the rights of another and cause them harm. Obviously, deliberately taking actions which may lead to someone else dying from septicaemia infringes on their RIGHT to health care!

And finally, who will be blamed? The doctor. Because it is his patient, because he is ultimately responsible for the actions of his health care team and because he will have to care for the patient through the prolonged hosputal stay, the wound sepsis, the septicaemia. The theater sister will give neither the patient, nor the outcome a further thought.