The whistle‐blower

Abstract

The term whistle-blower derives from English policemen blowing their whistle to sound the alarm. The unarmed policemen, known as ‘bobbies’ after the Prime Minister Sir Robert Peel who started the first police force, would blow their whistle when they saw a crime being committed, to alert other police and to warn the public of danger. The term is now used to denote an employee who reports misconduct within the organisation where he or she works. In my first ever full-time job, working as the most junior doctor on a surgical team in a small London hospital, I had the opportunity to be a whistle-blower and I blew it. Not the whistle, unfortunately. I missed my chance to blow the whistle and it still haunts me. A young black African mother of three small children was admitted with a pilonidal abscess. The abscess was drained in theatre by a medical student under the supervision of the surgical senior registrar. The patient was placed face down to drain the abscess, so was intubated and ventilated by a junior anaesthetic doctor. During the operation, the anaesthetist looked a little concerned and moved down to feel the femoral pulse. The surgeon raised an eyebrow, but the anaesthetist gave a reassuring nod. The patient's skin colour made cyanosis difficult to assess and it was in the days before pulse oximeters had been invented. At the end of the operation the patient was pulseless and the alarm was raised. A consultant anaesthetist rushed in, checked the endotracheal tube, muttered sotto voce, ‘It's in the oesophagus’, and re-intubated the patient. Later, the consultant anaesthetist said he could not be sure the endotracheal tube had not slipped out during the resuscitation. The patient died. When told, her husband asked tearfully if it was his fault for not getting her seen earlier. I wanted to take it further. Ranks closed. My consultant and senior registrar told me not to rock the boat. A coroner's autopsy found endomyocardial fibrosis, fairly common in East Africa, and the suggestion of an anaesthetic misadventure was never raised. To this day I wonder what direction my career would have taken if I had more courage. Maybe I would have reached Australia younger, like Stephen Bolsin. Stephen Bolsin was a consultant anaesthetist at Bristol Royal Infirmary in England. Cardiothoracic surgery was introduced de novo in Bristol, at least partly so the local Health Authority did not need to pay for children to be transferred to London for heart surgery. The learning curve was steep and the mortality at Bristol was as high as 30%. Even as he battled to reduce the mortality to below 5%, Stephen Bolsin was the sole advocate for these children, and was ostracised by his colleagues.1 Finally the truth emerged, senior heads rolled because of their attempts to cover up the scandal, and Stephen's reward was to be forced to emigrate to Australia, ending up in Geelong. The English transported convicted criminals to the colony of Australia from 1788 for over 50 years, with the intention of eliminating the so-called ‘Criminal Class’ from the class-obsessed English society. Ironically, Stephen Bolsin, who behaved with more courage, honesty and integrity than any in the sad Bristol saga, chose Australia as his sanctuary. Stephen Bolsin. Why is it that whistle blowers so often end up as victims? Instead of being congratulated for pointing out problems, they are often treated as if they are the ones who have sinned. It is reminiscent of children being told not to tell tales, with parents often blaming the tale teller instead of the miscreant. I think it must be that we know that we human beings often behave badly, and to an extent we collude with the bad behaviour and inherently condone it, so when a lone individual has the courage to stand up for good morality, we are all ashamed and make the whistle blower into a scapegoat. Whistle-blowing is usually thankless, damaging to the whistle blower, but incredibly admirable and courageous. To this day, I envy and admire Stephen Bolsin for being a better man than I.