Gynecological labor room is undoubtedly one of the busiest places of any hospital. But there are some days – however seldom – when one can sit and enjoy the absence of wailing mothers and crying babies (or catch up on the record-maintenance registers, one is always behind on).
However, the stories that surface during these rare respites sometimes, uncover just how malicious human nature can tend to be, and just how crazy this sanctum sanatorium can become, where the oblivious patients come seeking haven.
One such account was narrated to me by my nursing staff in the most nonchalant way. The case was of the two leading gynecologists in the department who had epitomized professional rivalry for the whole department to see. Let’s call them X and Y.
One day during the last summers, Y was going through her routine in the Operation Theatre. It was her OT day and she had a long OT list to work through. After successfully performing 2 caesarian sections, she advised the OT staff to bring in the next patient, put her under anesthesia and drape her to prepare for surgery. She went to her OT office to take a breather from long hours of standing.
When she returned, the patient was draped as she had advised. She performed the surgery, called the pediatrician to check the neonate and proceeded out to the counter to put notes on her file. As she closed the papers, she thought that the next time she would be seeing or hearing about the patient would be at patient bedside – during her ward round. She finished her jam-packed day and was about to drive home when the administration had her called.
Apparently, one of the doctors received a video via WhatsApp around noon. The video was making rounds on various WhatsApp groups and was sent to him by a concerned acquaintance. The video was of a certain female patient who had to undergo a caesarian section in the hospital’s OT. In the said video, the patient was entirely exposed – with no medical gown or any piece of clothing on her body – lying on the OT table, under general anesthesia with two male assistants (faces not seen in the video) chatting away, making lewd comments about the unconscious patient and draping her to prepare her for surgery. The video was focused on the naked body of the unconscious patient with the running commentary of those men in the background.
The administration was furious by Y’s inability to prevent this outrage from happening. She was given a warning, and was demanded to hand in a written explanation asap. The admin managed to somehow get the video taken off of the social media, investigated the case and suspended everybody involved including the very gynecologist Y, the anesthetist, the two male OT assistants (OTAs), the charge nurse and the female aya in that OT. It has been more than a year and none of the involved have been able to get reinstated – and rightfully so.
This whole account was as horrendous to hear as it was to write. But the exposition that followed was even more horrific. Apparently, the person who made the video was also an OT assistant who was stationed at the neighboring OT. That OT, which belonged to Gynecologist X. His OT shoes and his green colored OT dress pants were easily recognizable in the video but the biggest giveaway was his voice and his enticing comments about the patient’s bare body.
When I asked my narrator about why, for the love of God, was he spared from suspension even after being identified (because I see him in the OT even today); she told me that he was protected by X, on whose accord he recorded the video, in the first place. X wanted Y out of her department and away from her clientele. And she could not find a better method to resort to. She needed to defame Y; everyone else just became the means to that end.
Apparently, the entire hospital personnel knew about this debacle but were quiet to save name of the hospital. I don’t know whether it was the matter itself, or the unruffled demeanor in which it was being discussed, that was pushing me more into incredulousness.
Among the doctors, the nursing staff, the helpers and the ayas conversing over this matter in front of me, the concerns most vital were 1) How X is not someone to be crossed and 2) How Y was so savagely betrayed by the OT staff and none came to her rescue when she needed it.
Nobody was minutely concerned with objectively analyzing this wreck of an event.
1) Firstly, Y was absolutely undeserving of the sympathy, she was receiving by the hospital staff. The entire fiasco happened in her OT, under her watch. She was answerable to the authorities. Maintaining the privacy of the patient is an indispensable pillar of medical behavior. Medical ethics demand that she was not to leave a female patient, without a female chauffeur, unattended in the room, under any circumstance. More so, in an unconscious state. It is not merely the knowledge of medicine which warrants a license to practice this profession. The medical ethics are just as crucial to uphold the license. She was irresponsible to leave the patient unattended. Mere suspension from her government post was inadequate sanction for this ethical breech. Her medical license was not abrogated (she is able to pursue her private practice) and she was not faced with any monetary compensation to the patient.
2) Next, the onus of the matter lies on the OT nurse as much as it does on Y. Ethically, the doctor is only to ensure that a female patient has a female attendant in the room during any procedure. Practically, it is the duty of the attending nurse to either stand by herself or arrange a female helper to stand in her place. After advising about female attendant, the doctor can take his/her leave to prepare for the next surgery. But it is the duty of the nurse to carry out the advice and not leave the patient’s side. Sure, the nurse can have other duties to tend to, but not at the expense of an unconscious patient’s privacy.
3) Moving on, where on earth was the anesthetist? If he observed the absence of any female personnel in OT, he should have reported it. He should not have proceeded to administer anesthesia. He should have let her stay conscious and call for the appointed nurse. If he was unable to find her, or if she was busy in some other OT, he should have delayed the sedation until the doctor herself had arrived. If he had some other patient to attend to and he had to go ahead with the sedation at all costs, right there, right then, without biding his time, then he should have called at least an aya to come stand in the OT as the patient goes under anesthesia and remain there until the doctor arrives. But availing none of the options, he decided to administer the anesthesia. And then, not waiting for the operating doctor to come, he decided to leave. Leave the female patient in the company of 2 male OTAs to do her draping.
4) This, points one towards the stars of the video, the assistants: adjournment from the workplace was not nearly penalty enough for them. They should be litigated with harassment. They should have assault charges laid on them. Their medical experience/credentials must be stripped off. But no action was taken save the indefinite suspension. Upon discussing the matter with a police officer who is stationed at the hospital to deal with medicolegal cases, I was informed that it would be very difficult to hold the charges against those assistants in the court, due to the very fact that their faces were not visible in the video. In his experienced opinion, cases like these are not fated to see their culmination in our criminal justice system. There were more than just assailants and victims at play here, he said. Factors like the hospital’s repute, the prized medical license of the doctor, the inept social standing of the victim and the associated shame due to which the victim herself would be reluctant to take any substantial step, all influence such cases. Moreover, it would take minimally 4 – 6 months for that video to be analyzed by the forensic specialist in Pakistan Forensic Science Agency. And according to him, it’s highly unlikely that the family of that patient would persist in pursuing the case for so long, if at all which might ‘bring dishonor to their family’.
5) Which brings me to my biggest reservation with this: the patient herself. Was she even informed of how she had been violated in her unconscious state? Was she even aware that her video in a compromised state was making rounds on the phones of the entire area? Was she even cognizant of the fact that she was maltreated and that she deserved justice? The nurse told me that her husband was no stranger to her video and was even offered compensation by the hospital. But naturally enough, he declined. Her family wished to keep the matter under wraps and not dish it any more in the public realm than it already was. They did not desire to press charges and were determined to keep their family name out of controversy. I have my concerns about this: who knows if she was allowed to make an independent decision about the matter? Empowering the voice of their women is not the norm in families of their socioeconomic strata, rather the exception. There are more chances of her male counterparts of the family making that decision on her behalf to ‘save the family’s honor’.
6) Lastly, if everyone is so sure about X’s involvement in this entire farce, where was her retribution? I was told that X’s assistant who recorded the video, afterwards claimed – very proudly – to watch out for her ‘Madam Sahab’ who always got what she wanted. I talked to one of my seniors about the matter. He told me that although informally her involvement was public knowledge but there was no formal proof that could connect her to the whole case. Even the investigation committee’s best efforts bore no fruits due to lack of evidence and her august status. He further on went to state that the hospital had already suspended one gynecologist. They could not afford to dismiss another. Gynae OPD had the highest patient load and taking 2 hits simultaneously would not fare well with the department.
So, no court proceeding ensued. Hospital’s investigation concluded with suspensions. X acquired absolute and sole control. The patient’s family’s name was not maligned. The hospital’s repute was not blown to tatters. The assistants were not criminally tried. The doctor’s medical career was not affected (besides govt-post suspension). Everyone continued on. And it became just another one of those anecdotes about dirty-office-politics which you discuss on tea breaks.
The idealist in me struggled to understand the psychological state of the patient. Would she ever feel safe while getting examined now? Would she be able to undergo any procedure free of fear? Probably no. Would the men in her family allow other females to seek medical attention if the need arises, after this experience at their hands? Probably no. Would the fact that her assailants would resume their positions in this hospital someday, ever restore her faith in the idea of justice? Probably no. But the million-dollar question is, if medical personnel are only trained in medical knowledge and not medical ethics; would it be possible to prevent a similar episode from recurring? Definitely no.
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