No one offered, of course, and he pointed at me and said,
“Blake? Let’s hear about decubitus ulcers.”
I talked until I was hopelessly over time with this but Dr. M didn’t stop me, he let me finish.
I was exhausted by then. I could feel sweat trickling down my back, and I couldn’t look at Andrew without remembering how we had been the night before. Fuck.
“How much of what actually happens here, on the wards, is evidence-based?” he asked the others. “Blake? Did you find that statistic during your adventures in Wonderland?”
I shook my head. Damn, I should have found that out.
“Medical mythology has it that ten to fifteen percent of what we actually do is evidence based, that is it is grounded in sound scientific process. You all probably want to write this down,” Dr. M said. “And put it somewhere you can see it everyday.”
There was silence while we scribbled, and Dr. M smiled at us all. “Actually, a mere fifty-one percent of all medical care flies in the face of science.”
“Why do we do it, then?” Lin asked, face creased with dismay.
Dr. M crinkled his eyes at Lin. “Because we can’t bear to leave the patient to suffer, so we try anything we can.
Because we’re talking about the human body, not a machine, and we don’t actually understand how it works. Because the way to provide scientific proof for the treatment is too hideous for an ethics committee to approve. Can any of you think of examples of treatment on this ward, right at this moment, where there is consensus it’s the right thing to do and there’s no scientific rationale for it?”
“Um,” I said. “There’s the man with the abscess on his leg that’s growing pseudomonas. He’s being treated with antibiotics that MCS said the bug was resistant to.”
Dr. M nodded. “Five grams of amoxicillin a day. That’s a toxic dose. There isn’t any reason why it should help, but his WBC this morning has dropped. He’ll eventually get better by himself, we’re just giving him a bit of a hand to get started.”
He checked his watch. “We’re out of time. I’m off to a stop work meeting. Haven’t been to one of these since I worked as a labourer. If you want to observe, you’re welcome to come along, too.”
Did I want to watch? Oh, yeah. It was another chance to watch Andrew being impassioned about something, and while it wasn’t quite as personally rewarding as watching him being impassioned about me, it would still be good.
Chapter Twenty
The last meeting had been full of drama and threats, but this one was calm. The collective will of the staff was palpable from the moment when F stood up, piece of paper in his hand, and said that he had been sacked, effective immediately.
There really wasn’t any need for any of the discussion after that, but we went through the process, making sure that the minutes included discussion of the ethical implications of our actions.
F looked subdued, and sober, and I could just about imagine how it was for him. I was an interloper, trained in the US, and I’d only been at the hospital for two years. F, on the other hand, had been there for ten years, apart from a sabbatical in Philadelphia for research. This was his home, for all its failings.
I’d prearranged with the BMA rep and the independent lawyer they’d brought in to the chair the meeting that I’d be the one to propose the motion that we take industrial action, and after three-quarters of an hour I put my hand up.
“Madame Chair, Dr. Maynard, Registrar. I’d like to propose the motion that in protest at the administration’s disciplining and dismissal of Dr. Seagate that the medical staff withdraw their services from this hospital for eight hours on Monday the 23rd.”
Big words, that were going to mark me forever as a troublemaker, at least in the UK medical system, and I didn’t fucking care. They hired us to do a job, then fucked us over when we did it. This wasn’t enough, but it was a token of support for F, who was the best damn renal doctor I’d ever met.
The room was silent, but I could see F’s face, and his eyes were wet. Damn, I felt the same way myself.
Clarissa Jax, who was a surgical resident and the BMA divisional rep, with a background in student politics, raised her hand. “Madame Chair, Dr. Jax, Resident. I second that motion.”
“Dr. Maynard,” the chair said. “Would you like to speak to the motion?”
I stood up and turned around to face the crowded room. “I would, Madame Chair.” The room was completely full, packed with far more white coats and stethoscopes than I would ever have imagined. There was a hell of a lot of BMA membership cards pinned to pockets, too.
I spotted Matthew at the back of the room, with Lin and Nevins and the rest of the group. Word had obviously gone out on the med student grapevine because there were a lot of other short coats in the room.
“Dr. Seagate did what we all do every day; he attempted to circumvent the artificial restrictions the administration places on our practice. He was trying to get the speedy surgical review that his patient needed. It was no different in essence from all the times we talk to each other in the cafeteria or car park, bypassing the administration’s channels.
No different from buying roses for Gracie in outpatients to bump a patient up the waiting list, no different from a surgical registrar re-diagnosing a patient to change their place on the waiting list.
“He received a formal letter of discipline from the Director of Medical Services, and took the matter to the BMA for consultation. It was this act, that of consulting with a union lawyer at a meeting in this room, that led to his dismissal.
The United Nations Universal Declaration of Human Rights, of which Britain is signatory, Article 23, clause 4, states that ‘Every person has the right to form and to join trade unions for the protection of his or her interests.’”
I paused, gave them time to think about it, then said,
“That is why we should take industrial action. This administration has dismissed one of us for doing exactly what we are doing now, organizing.”
I sat down and pushed my hands between my knees to stop them from shaking. The room was silent, and my ears were ringing. The Chair said, “Dr. Jax, do you wish to speak to the motion?”
Clarissa stood and said, “Not at the moment, thank you.”
“Does anyone wish to speak against the motion?” the chair asked, and then it was on. Abrogation of duty of care.
Hippocratic oath. Socialised healthcare. I didn’t speak again; I didn’t need to.
After fifteen minutes, when I could no long bear it, I raised my hand, and the chair halted the lawyer and said, “Dr. Maynard, do you wish to withdraw your motion?”
“No, Madame Chair,” I said. “I wish to move the motion that the first motion be put to the vote without further debate.”
There was a chorus of seconders, and the chair said, “I will now put the motion that…” She glanced down at her notes.
“…that in protest at the administration’s disciplining and dismissal of Dr. Seagate that the medical staff withdraw their services from this hospital for eight hours on Monday the 23rd. Those in favour say ‘Aye’.”
There was a resounding chorus of ‘Ayes.’
“Those against, say ‘No’.”
It certainly wasn’t unanimous.
One of the administration’s lackeys stood up and said,
“Madame Chair, I request a secret ballot.”
“A reasonable request in the absence of a clear majority,”
the chair said.
There was a five minute recess while the ballot was counted, and I checked my watch. It was after six. I was going to be late collecting Henry, but that was hardly anything new.