Bad Doctor

Unusual discussion a few days ago.

We were looking at the medical roster, with all of the spaces where it was meant to say "Dr so-and-so working this shift", and running through the usual strategies for making sure we weren't overwhelmed:

( - Standing out the front of the hospital with those glowing sticks like they use at airports, waving people on to the Royal.

- Walking through the waiting room in one of those biocontainment suits, especially if we can get one with pincers for hands, saying "There is no cause for alarm. Repeat, there is no cause for alarm."

- Having a quick chat with any doctors who want to leave and reminding them that we can always detain them under the mental health act

- Mass consultations, with one doctor simultaneously treating six or so patients who have the same pathology in the same room: "Right, on the count of three we're all going to take a tablet of anginine and let it dissolve under our tongue. One, two, three. Excellent. Now, I'll be back in five minutes to check who still has chest pain....")

when Dr Quinsy, one of the senior consultants, had an idea.

"Why don't we ring Kuki?" he said. "He works hard, he's easy to get on with. And he's free"

There was this stunned silence. Dr Kuki was, indeed, free. He was free because he had been sacked from the Royal, asked to leave by Shipton and had had his employment terminated by the only locum service in town. Last I heard he was applying to be one of those doctors who goes to the kickboxing tournaments. We all know about this because this has recently been printed in the Daily Sackbutt, the local newspaper, which has been following the progress of a coroners report into a patient Dr Kuki appears to have killed a few years ago at Lazarus.

He is one of the three truly bad doctors I have met.

I worked with him at Shipton, when I was more junior. And he wasn't stupid, and he wasn't ignorant, and there was some stuff he knew quite a lot about. And he could, on occasion, work quite hard, and he was pleasant to work with - you could share a joke with him, you could ask him stuff and he was helpful, he'd teach you stuff.

But he had two big problems. Looking back, they may have been different facets of essentially the same problem, but either way they were crippling.

First was - I don't know whether to call it an ethical problem or a "antenna" problem. On the first day I met him I was showing him around the ED (emergency department) and I said "Here's the trolleys for suturing, gynae, getting stuff out of a kids nose, that kind of stuff" and he said "Cool, I've always wanted one of them. Can you give us a hand to load it into the back of my car after the shift?".

And he was serious, and he was some guy I'd only known for half an hour asking me to steal from my employer.

And then stuff started to go missing, lots of different kinds of things, irritating little things like where you'd go to get some thing out of a kid's nose and someone's flogged that "bright light on a headband" thing you use, which would set the whole thing back half an hour.

And he swore, too. Now, I have sworn at work. Two or three times where patients could hear: I swore when I stabbed myself with the needle, and I swore when the resus bell went off when I was in the other resus, and in the fishbowl (that big room in the middle where the doctors and nurses sit and imagine that the patients can't hear them) many, many people swear. But people don't want to hear that.

Note: the following contains un-necessarily graphic and deeply disturbing mental images. If I could put it on one of those "click here to read on" things I would. And yes, I'm a prude.

But Dr Kuki swore all the time, to everyone, patients, staff, you name it. I remember one time when we were walking through the waiting room, surrounded by children and little old ladies, and he's complaining about some recent proposal from administration, and he's not saying "I feel they have treated us unfairly", or "They are clearly not in accord with subsection three paragraph q of the industrial relations commission ruling". He's waving his hands and raising his voice and howling "And if that's their fucking attitude, they can all suck my cock! They can suck my big purple veiny cock!!"

And so on.

But the main thing that got stolen, and this I think is what made him dangerously bad, was the drugs. The Daily Sackbut said that on the night when he inexplicably sent some poor old Italian woman home to die, he had accidentally stolen the wrong drug from the pharmacy cupboard (he had meant to steal citalopram, his anti-depressant, but instead had stolen diazepam, a sedative).

I doubt this to be the case. He had a serious drug problem. The Sackbut revealed that he smoked marijuana, but to the best of my knowledge he never came to work intoxicated. But he stole diazepam (valium) and alprazolam (marketed over in the US as xanax) and anything with codeine in it and pretty much anything that he could find. I almost never worked on the same shift as him, but the effects of these drugs, in moderate doses, can be difficult to pick - s someone sleepy because they're tired? Is someone relaxed because they're that kind of person? Is someone making decisions that seem dodgy to the nurses because -well, because he's senior to them and he's seen more cases like this than they have and anyway, he's the doctor?

Towards the end, by which time he was working supervised at Shipton, he would drift off to sleep at the slightest opportunity.

There are lots of questions here. How things got so bad. How they were allowed to stay so bad for so long. And how many undetected errors of judgment are waiting to be uncovered - this current story in the Sackbutt happened four years back, he was at Shipton only two.

Anyway. I told Dr Quinsy that I was not working in the same ED as Dr Kuki again. Dr Kuki, while hard-working and easy to get on with, had problems that made him unemployable. And no matter how bad things get, with us being short-staffed and so on, they can always get worse.