The anatomy of a mess

I was horrified this morning when I realised that all Ranjan's chemo discharge files from 2 to 7 had a glaring discrepancy between pages 1 where it is clearly written that no Dexona is to be given to the patient and page 4 where it is stated in the list of premedication that it has been given. I noticed this on August 19 as Ranjan was acting strange and I checked the file and SMSd the oncologist. He assured me that it was a mistake and would be rectified. In hindsight I am feeling awful not to have checked. I thought that as all this was a printed format it was a simple typing slip up of the nurse not deleting the Dexona from the protocol list. I now remember Dharmendra telling me on the phone that the '4' premeds had been given and not reacting to the number four. Somehow the glitter and glam aspect of these super speciality centres lulled me into a false sense of complacency and made me believe that at least in such places, such mistakes could not occur. How wrong I was!

Now that my anger has cooled down a little, I will try and dissect the issue. It is a fact that I have always felt that this chemo day care centre is poorly organised and have been dying to give suggestions as one of my forte is organisation, but held back as I thought that it was not in my place to do so and did not want to rock the boat for Ranjan. But now I feel compelled to at least write this blog to give you an idea of how it runs and how things can go wrong.

Before I do so, I would like to share how we handled conference documents in Summits where I headed the multi lingual Technical Secretariat. We had pre conference documents, in conference amendments and the final document. In conferences of this level even a coma can change everything and create diplomatic incidents. If a mistake should occur then you face the wrath of the likes of Indira Gandhi or the Foreign Secretary and also get ridiculed in sessions. When a document would reach us after being vetted by the conference secretary it would go to a pool of translators and then to a revisor. It would then be sent to the typing pool and then be proof read. It then be duplicated and come tome before being sent to the conference hall! I can say that in my career as Conference organiser I never let a mistake pass. Even if the delegates were screaming for the translations we never broke our system. That was the reason for our success rate.

The chemo centre runs much like the rest of India in a sort of crises management mode. Patients arrive by 8 am and after useless paperwork that has to be done each and every time - wonder why they cannot enter all the information on their computers and hand you a print out to sign - you enter the day care. The staff is also in the process of checking. First mistake. Staff should be in place and at their stations an hour earlier. Then your vitals are checked and then you are left unattended. When you ask the junior nurse you are told that the junior doctor has to OK the medication. Then you wait some more and the junior doctor arrives and asks you if all is well and then disappears. You ask the nurse again why they cannot at least place the needle in the port. You are told that it can only start after the doc's OK. By that time you have waited an hour. You then go to the desk where the junior doctor sits and ask her what is happening. The answer is that she is waiting for an OK from Senior Doc whom she has messaged. When that arrives then the show begins. The feeling you get is that no one knows anything and is waiting for Godot.

Now let me enlighten you a little. Most of the patients are the same on a given day. The cycle is a fortnightly one. You are told in your discharge papers to get your CBC counts down and inform the hospital a day before the chemo. I SMSd these to the oncologist. The likely hood of anyone having a problem is according to me less than 2% as I have seen the same faces getting their chemos again and again. So of the system worked the medication protocol should be worked out, signed and countersigned the night before.If this was the case, your chemo could start by 8.30am and not 10 am as is the best case scenario.

But that is not so. Sending information earlier is of no use. It is all done in the morning in a state close to panic as everyone is anxious to start the show.

Let us go on. Once all papers are signed and your pre medication given you have to wait as the pharmacist has either not arrived or is in the process of making the cocktails for each patient. Again it is done under stress and the likelihood of an error is there.

In Ranjan's case, no one bothered to read page 1. I guess they should skip to page 4 where the normal premeds protocol is written as the correction was never made and the 4 medicines are put in a saline drip. I was at the right place at the right moment and saw the bottle with the 4 names scribbled on it. Had I not seen it, Ranjan would have had another bad experience. And yet with a little organisation things could work well. Actually in a hospital of this reputation it should be clock work orange. The system followed is haphazard with no proper direction or delegation. I am sure that if everyone was given a fixed responsibility and a final check was done by the doctor on duty with the patient file and the medication bottle, all would be well.

There is more. As I wrote in an earlier blog, it took us an hour to get a simple discharge slip. After the proverbial Indian crisis management we faced the proverbial bureaucratic system of a series of no objections. The person giving the slip is on the same floor than the chemo care centre. Yet we were told that the paper had to go to several floors whether virtually or manually as was the case yesterday. Come on, you want to run like an international outfit but cannot get rid of the Indian small shop attitude.

All this would be acceptable in a small mufassil town or at a big overcrowded state run hospital but when you enter the portals of a five star hotel like lobby, replete with fast food outlets and book shops you expect basic efficiency and responsibility.

The cherry on the cake is that in the chemo centre every patient has to have an attendant keeping a hawk eye watch on the drip and the patient. This is a government hospital rule not befitting a medical palace that is replete with suits of all kind who are masters at collecting dues or trained to seduce you into handing out more than you have.

I still do not know how I will take this further. At present I need to keep things going as Ranjan still has 4 more chemos. Time will tell but I know I will not keep shut.

I still feel the guilt of having subjected Ranjan to unnecessary hurt. As Voltaire said:" Every man is guilty of all the good he did not do.” I am too.