Violet
‘I know he’s like a total snack; we were all in love with him at medical school, but he's properly off the market. Got engaged last year to his long-term girlfriend, broke about a billion hearts.’
‘Very wise,’ said Anjali who now seemed to be struggling to keep her own facial muscles under control. ‘Forget I said anything. Have you managed to get the blood gases done on Mrs Anderson yet?’
‘Anyway,’ she continued. ‘Mr Newton’s kidney function was all over the place so I told the staff nurse that a high dose of the medication she was suggesting could potentially kill him.
’ She paused. ‘Actually, I think I might have upset her– the staff nurse– she told me there was no need to be quite so rude and patronising. And then, well, she didn’t speak to me again. ’
‘Thank you. I really hate doing blood gases.’
‘I know you do.’ Anjali laughed, and then she frowned.
‘Take a look at Mr Zeller’s notes, Violet, before you go and speak to him, okay?
From what the team in A&E said, I don’t think he has any idea of what’s about to hit him.
And they didn’t have the time to drop any hints.
Too busy dealing with the steady stream of festive drunks.
You might need to be a bit– uhm– delicate . ’
Violet’s insides turned over in alarm. ‘I don’t really do delicacy,’ she said. ‘You remember what that patient said about me last month, that I had the bedside manner of Dr Crippen.’
‘The man with the liver disease?’ Anjali seemed to be stifling a laugh as she recalled the incident. ‘Oh, he was just upset about the diagnosis. I’ve seen him before. He blames everyone else for what’s happened to him. I think he was just a bit surprised that you gave it to him both barrels.’
‘I only told him he had to stop drinking or he’d die of hepatic failure,’ said Violet. ‘It was the truth after all.’
‘Yes but you know what they say about patients,’ said Anjali, putting on a strange American accent. ‘They can’t handle the truth.’
‘What?’
‘Sorry, I was trying to be Jack Nicholson in A Few Good Men ,’ Anjali said. ‘But I guess it’s a bit before your time. Anyway, I’m sure you’re perfectly capable of being sensitive and diplomatic. Just have those skills in the forefront of your mind when you’re seeing Mr Zeller, yes?’
Violet nodded but pulled a sceptical face as she pocketed her phone and Anjali clearly felt compelled to speak again. ‘And, while we’re talking about diplomacy,’ she said.
‘Ye-es.’
‘Don’t worry, this isn’t a telling off. It’s just…’ Anjali’s next words came out in a rush. ‘Do you think you could be a bit more tactful with some of your ward colleagues?’
Violet’s heart sank. ‘Tactful?’
‘Like, the discussion you just mentioned, about Mr Newton’s kidney function and telling the nurse that her suggestion might kill him.’
‘But…’ Violet was confused. ‘You don’t think I should have prescribed a high-dose diuretic, do you?’
‘No, I don’t. But maybe you could have handled the situation a little better?’
Violet paused, trying to pick apart the detail of what Anjali had said.
‘But– it’s a binary choice. I either prescribe the drug and mess up his kidney function further, potentially causing a lot of damage– or I don’t.
’ She looked up at Anjali, trying to gauge her expression.
‘I made the right clinical decision– didn’t I? ’
‘Well, yes but…’
‘So– what did I do wrong?’
‘Well, you’ve clearly upset one of the nurses by speaking to her in a…’ Anjali now seemed to be struggling to find the right word. ( Welcome to my world , thought Violet.) ‘In a…’
‘Factually correct manner?’ she offered.
‘I was going to say, a dismissive manner.’ Anjali paused. ‘It just might make your life a bit easier if you were more, uhm, thoughtful in how you approach your colleagues.’
‘But’—a furrow had appeared at the top of Violet’s nose as her brows knit together—'I don’t want to do something wrong.
And I don’t want to lie and pretend that I’m going to prescribe something I’m not.
I’m sorry if I was rude.’ She sighed. ‘It’s not because she’s a nurse.
It’s just that what she was suggesting was medically incorrect and possibly dangerous, so you know, I had to tell her… ’
‘I know. As I’ve said, my comment wasn’t really about the clinical decision itself. And I know it’s not about her being a nurse. I’ve seen you be just as blunt with visiting professors.’
‘Exactly.’ Violet felt relieved. At least Anjali knew she didn’t have a superiority complex.
‘But that’s not necessarily a good thing either.
’ Anjali’s eyes scrunched up at the corners.
‘Look– I didn’t want to have to tell you this over Christmas,’ she said, taking another deep breath before she continued.
‘But you need to know, and it might as well be now– two members of staff have put in a complaint about you.’
‘About me?!’ Violet was horrified. ‘Why? I– I’ve not made any mistakes. Have I– is it a prescribing error or a misdiagnosis or…?’
‘It’s nothing to do with your clinical skills, Violet.’ Anjali’s voice was gentle now. ‘Nobody has any concerns about you medically. It’s just what we’ve been talking about.’
‘The nurse on ward twelve has complained? Already?’
‘No, Violet. It’s not her. At least, I don’t think it is.’
‘Well, who is it then? Am I going to get struck off?’ Violet suddenly felt sick. It wasn’t even one in the morning and this was already turning into an extraordinarily bad Christmas Day.
‘I’m not exactly sure who it is,’ said Anjali.
‘Just two clinical members of staff, could be nurses, physios, other doctors, I don’t know.
But you’re not going to get struck off. They’re not medical complaints – everyone knows you’re a competent doctor, more than competent, you’re hard-working and so knowledgeable.
I’ve seen you interpret lab results and reel off differential diagnoses with your eyes closed.
Really, please don’t worry about your clinical skills.
As far as I know, their concern is regarding– how to put this– the problem is more about your attitude . ’
Violet could feel tears prickling at the back of her eyes. She dropped her gaze to the floor and gulped hard. It wasn’t the first time she’d heard this. Memories of medical school came flooding back.
Anjali reached out and touched her hand. ‘I think Dr Corbishley is planning on having a word with you when he gets back from his skiing trip. There’s nothing to worry about– but it seemed fairer to put you in the picture now. Particularly while there’s still something you can do about it.’
‘What can I do though?’ Violet lifted her gaze and looked Anjali directly in the eye. ‘What can I do about my problematic attitude ? It’s just me. My personality. It’s who I am.’ She shrugged Anjali’s hand away sadly. ‘What am I supposed to do about that?’