Morale of Halifax physicians, medical students takes a hit
The Morrison case has shaken morale at Dalhousie University medical school and the Queen Elizabeth II Health Sciences Centre (QE II).
"The negative impact has been huge," says Dr. Elizabeth Anne Cowden, head of the Department of Medicine at Dalhousie and the QE II. "That's extraordinarily unfortunate, because the reality is that medical staff, nursing staff and paramedical staff are truly committed to providing optimal care."
When respirologist Nancy Morrison was arrested and charged with first-degree murder last May, many faculty and hospital personnel knew nothing of the events surrounding the November 1996 death of 65-year-old cancer patient Paul Mills at the QE II.
"The reaction among faculty, particularly in the Department of Medicine, was one of absolute shock," says Dr. John Ruedy, dean of medicine at Dalhousie. "In the Department of Respiratory Medicine, it was one of almost acute grief reaction, with some members being almost immobilized in their ability to continue to provide clinical care."
He says undergraduate medical students, who had recently named Morrison professor of the year, were "extraordinarily upset" and weren't sure "what to do or what action to take."
"The word 'murder' is very disturbing," he says, noting that students "overwhelmingly" support Morrison. "Part of the shock to the students was their uncertainty . . . as to the greys in this situation." Ruedy says some observers do see the case in black and white "but for most people our values and our beliefs are not firmly entrenched, and we're insecure. Of course, students are even more insecure about what they should value and believe [about] the end of life."
In addition to the charge and the handling of the arrest -- nearly 40 police officers descended on various sites at the QE II -- Ruedy says the rumour that another QE II doctor had reported Mills' death to police fuelled suspicion and "seriously undermined physicians' confidence in the processes and system within the institution." Morrison's colleague, respirologist Arthur Macneil, contacted police in late March.
For students, final exams "cut short what might have been a much more difficult and troubling time," Ruedy says. But for clinical faculty and other QE II personnel, the timing of Morrison's arrest couldn't have been worse.
For about a year, staff had been gearing up for the merger of the hospitals and other institutions that form the QE II, and by early spring the move had started. "On top of all the fatigue and stress that had resulted from the preparation and implementation of the merger, [the Morrison case] has taken an enormous toll, not simply on physicians within the Department of Medicine but on everyone who functions in the institution," says Cowden.
Cowden, whose department includes the Division of Respirology, learned of Mills' death in December. "I was quite shocked and apprehensive and concerned. I was concerned about the patient, the patient's family, Dr. Morrison, the Critical Care Unit and how it functions, and the Division of Respirology and how it functions."
Cowden points out that health care delivery depends heavily on trust and cooperation. "[The health care teams] are not functioning normally right now. There is not the comfort or the communication or disclosure. The normal team relationship is clearly fractured."
After the arrest, the hospital brought in a "stress team" and tapped its employee assistance program to help distressed staff. Cowden says the Department of Medicine has since decided to use an assistance program that has debriefing and facilitation phases to "develop a strong functional team once again," especially in the Division of Respirology.
Morrison, who was suspended and then resigned from the CCU, returned to work at a QE II outpatient clinic in July. The strain created by her arrest isn't expected to disappear overnight. "The intensity of the reaction has diminished," says Ruedy. "Quite clearly, it will reintensify as each new snippet of information becomes available."
