Friday, 5 July 2013

The Doctor as Patient

I recently had a procedure done, which gave me the opportunity to put myself into the role of patient rather than physician.  I tried really hard to not let on that I was a doctor, but eventually I let something slip which made one of the nurses realize that I was in the medical field.  It was illuminating to be the man on the gurney; I hope it doesn’t have to happen again for a long time.

I arrived at the appointed time, and after filling out some mandatory paperwork, I sat around for a while waiting to be called back.  I scheduled my procedure for first thing in the morning so I could reduce the likelihood of delays.  Carolyn kept my mind occupied with small talk, and I tried to respond appropriately, but all I could think of was what was to come.  As an anesthesiologist, I have seen all sorts of misadventures occur even with the most benign and least invasive procedures.  All of those incidents came rolling through my memory as I sat there.  As I handed my valuables over to Carolyn, I prayed an act of contrition and tried to resolve to accept whatever came to me this day.

When they called me back I jumped right out of my seat and was almost through the door before I realized I had not kissed Carolyn good bye.  I turned back, kissed her and told her ‘I love you’ and then I was alone with the medical team.  I was led into a typical pre-op bay with walls on three sides and just a curtain on the fourth side.  I sat on a gurney, where there was a hospital gown and a bag for my clothing.  After a brief interview the nurse gave me an overview of the risks of the procedure and the sedation I was about to receive.  She talked about how I might experience some discomfort from gas pain afterwards, and that the best way to deal with it was to let it out rather than holding it in.  She used an expression which I thought was priceless; one which I shall adopt in my own practice.  She told me to act like a ‘Linebacker in a Locker Room’ when it comes to letting the gas out.  I laughed.  Next, I was told to change into a hospital gown (“Open in the back, untied.”) after removing the rest of my clothes.  The nurse pulled the curtain closed as she stepped out.  

I had never thought about how to change into a gown before.  First of all, I was very self-conscious, knowing that there was only a curtain between me and the world outside.  Second, I was cold to begin with.  I had worn shorts and a shirt and a pair of Crocs so that I did not have a lot of clothes to deal with, but the day was abnormally cold for July in Texas.  I wanted to change and get under the blanket on the bed as soon as possible.  It suddenly occurred to me that the best thing to do was to remove my shirt, put on the gown (open in back), and remove everything else under the cover of the gown.  I thought I was pretty smart.  

Around this time the nurse called in to see if I were ready.  I said I was, and both sides of the curtain were pulled back as a nurse approached me from both sides.  In a matter of moments I had a set of electrocardiogram (ECG) leads placed on me and my blood pressure, heart rate, and oxygen saturation taken.  While the nurse on the left was checking my vital signs, the one on the right applied a tourniquet to my right arm and started looking for a vein on the back of my hand.  I asked what my blood pressure was; it was high.  I figured it was because I was scared; considering the procedure I was about to have, one might say I was scared sh**less.  Both nurses laughed, saying that my blood pressure was high because I had given Carolyn ‘some sugar’ before coming back for the procedure.

About this time, the nurse on the right told me to open and close my fist and then relax.  She placed an IV  catheter in the back of my hand and I barely felt it.  I asked her what size it was while I glanced at my hand.  Before she could answer, I said, ‘oh, it’s a twenty-two,’ meaning a 22 gauge catheter.  At this point she asked me if I was medical, and when I told her she laughed about how I just sat there and let her tell me all about the procedure.  I told her that I appreciated that she treated me like any other patient, and I also told her that I would use her line about the linebacker in a locker room when I talk to my patients.  After placing the IV, I was left alone in my little bay.  The fluorescent lights above seemed a little harsh.  I prayed, and wondered how much time had passed since I had come back there.  

My next visitor identified herself as a nurse, and that she would be giving the sedation.  I asked her if she were a CRNA (nurse anesthetist), and she said yes.  She also went over my history.  I was a little surprised that no one had listened to my heart or lungs yet.  One of my surgical colleagues told me that when one of his children had surgery, four people listened to the child’s chest - but only one documented what they heard.

The circulating room nurse came by next, and along with asking some of the same questions, she verified my NPO  times - NPO meaning nil per os in Latin, which means ‘nothing by mouth.’  With the procedure I was having, I had to abstain from solid food for more than 24 hours beforehand, so I told the nurse about how I had gone shopping at Costco the day before.  I told her how they had samples of stuffed jalapenos wrapped in bacon(!) so the whole store smelled of bacon.  She laughed.

Shortly thereafter the doctor came by to talk to me.  He said he wanted to see me about a month after the procedure, and that he would talk to Carolyn and me afterwards.  He said I would probably not remember it.  

A minute later the circulator started rolling me back to the procedure room.  It was rather strange to be riding in a gurney.  It reminded me of a roller coaster ride, where one has no control, and it appears as if the ride is going to hit walls or other obstacles.  I kept waiting for the gurney to strike a wall, but it never did.  As we entered the room, the CRNA I saw before started putting on monitors and took off my glasses.  When she saw my scapular, she said that I must have been praying before I came into the room.  I told her I still was.  After the monitors were in place, I was told to lie on my side.  I was aware that the CRNA was hooking up an infusion of propofol into my intravenous line.  I looked at my blood pressure which I could see on the monitor near my face, and it looked good.  The last thing I remember doing was asking how long the procedure would take.

The next thing I remember was waking up, back in a bay similar to the one where I had started.  A nurse I had never seen before told me that everything was done and that I could get dressed.  Carolyn was suddenly there, and she helped me get dressed.  The doctor stopped by and told me everything looked good and to see me in a month.  As soon as I was dressed, I was escorted out to the car which Carolyn had pulled up front.  I was surprised that I was not required to drink something before discharge; maybe I did drink something and just can’t remember.  Either way, this is different from the pediatric world, where our patients get general anesthesia for this procedure.  Also, children are at greater risk of dehydration than adults.  

I recall going home and resting intermittently for the rest of the day.  I felt funny and didn’t complete any of the desk work I had planned to tackle that day.  

In the 1946 edition of Medical Ethics for Nurses, by Charles J. McFadden, OSA, Bishop Fulton J. Sheen wrote,

“Every good nurse ought to have two things: A sense of humor, and an incision.  A sense of humor in order that she might spread joy and gladness; an incision in order that she might have an experimental understanding and appreciation of pain.”

This applies to doctors as well.  For me, this experience did not involve any painful incisions, and Carolyn teased me how it was really nice for me to be able to recover so quickly after my procedure instead of suffering a lot of pain afterwards.  But it still was instructive for me to experience the fear and humiliation which comes with being a patient.  I tried to imagine what the experience must be like for those who are not in the medical field.  I knew what was happening to me the whole time; I anticipated all the actions of those who cared for me.  All of the folks at the surgery center acted professionally and empathetically at all times.  But I was still scared.  I hope that this experience will help me treat my patients with a bit more respect and sympathy.    

So what was my procedure?  If you haven't guessed what it was, just watch this song about it:

Friday, 23 September 2011

CMA UK Midlands/ Worcs 2011

Catholic Medical Association Meeting Thurs 20 Oct ‘11

‘Induced Abortion: Its effect on Mental Health’

Speakers: Drs Pravin Thevasathan (CMA Worcs Branch Secretary, Cons Psychiatrist LD) & Greg Gardner (Birmingham GP and protestant ethicist for Midlands Ethics Group)

Chair: Dr Tony Cole
Venue: Newman House Catholic Chaplaincy, 29 Harrisons Rd, Edgbaston, Birmingham

19:30: Mass
20:10: Meeting Followed By Discussion & Light Buffet

To assist with catering, would those wishing to attend please notify (email) John Kelly ( by 12 Oct.

There is no charge for Buffet

Sunday, 14 August 2011

Sirach 38:9,13

My Child; when you are ill, delay not, but pray to God, who will heal you... There are times when good health depends on doctors, for they in their turn, will pray the Lord to grant them the grace to relieve and to heal, and so prolong your life.

Thursday, 28 April 2011

Catholic Embryo adoption?

Once immorally conceived in a Petri dish, instead of through the loving marital action, should 'surplus' embryos be discarded or would it be morally right to implant an embryo to save it.

Yes: Jo Shaw
Dr Gerard Nadal

No: John Smeaton
Fr John Fleming (Bioethicist advisor to SPUC) Book
The Vatican(?)

I think this article of Dignitas Personae clarifies in my mind that it is not right and we must not cooperate with evil:
With regard to the large number of frozen embryos already in existence the question becomes: what to do with them? All the answers that have been proposed (use the embryos for research or for the treatment of disease; thaw them without reactivating them and use them for research, as if they were normal cadavers; put them at the disposal of infertile couples as a “treatment for infertility”; allow a form of “prenatal adoption”) present real problems of various kinds. It needs to be recognized “that the thousands of abandoned embryos represent a situation of injustice which in fact cannot be resolved. Therefore, John Paul II made an “appeal to the conscience of the world’s scientific authorities and in particular to doctors, that the production of human embryos be halted, taking into account that there seems to be no morally licit solution regarding the human destiny of the thousands and thousands of ‘frozen’ embryos which are and remain the subjects of essential rights and should therefore be protected by law as human persons” (n. 19).

However, I am very impressed with the 'Yes' arguments and to avoid post conciliar stagnation, i'd welcome lively debate around this issue. From a doctor's point of view, I'd want to know the practicalities eg. Consenting biological mothers for donation rather than just storage. An interesting topic. As John Fleming says regarding Dignitas Personae
It’s as if the church is saying to the secular world: “You created this situation by wantonly and irresponsibly creating human embryos in vitro and you are asking the church to solve the problem. It’s up to you to solve this unjust situation yourself by stopping creating embryos outside the body and freezing them.”

Sunday, 24 April 2011

Sunday, 17 April 2011

A very medical Palm Sunday

Forget the 'Passion Sunday' you may hear (that was last week) today is Palm Sunday. A restrained and yet intensified aspect of Lent and Passiontide: the point of entry into Holy Week and the culmination of our Lord's Passion. For that reason in the traditional liturgy the procession would have been clothed Violet, with the Cross veiled, and the Ministers wearing folded chasubles. No Red Vestments for the Mass: The violet colour of Lent and our Lord's royalty is retained. Although modern liturgy gave way to a forward-facing table to distribute palms (a Bugnini innovation which led to the 'table-altar); the traditional form involved a miniature 'mass' with blessing having its own collect and preface, and distribution of blessed palms (corresponding to the consecration of the species at Mass with communion).

Peter Jennings © 2008
The congregation would then join a procession to a stational church, all holding blessed palms signifying the triumphant entry of Christ into Jerusalem.
Glória, laus et honor tibi sit, Rex Christe, Redémptor: Cui pueríle decus prompsit Hosánna pium.
R. Glória, laus et honor tibi sit, Rex Christe, Redémptor: Cui pueríle decus prompsit Hosánna pium.

This quickly turns into sorrow, as arrival in the second church gives way to the Red Vestments and Mass proper, whose chant includes Psalm 21. Then the solemn singing of St Matthew's Passion during the Gospel, sung by coped clerics. This has been set to music by many famous composers.

But today I am sitting in the Doctors mess at a local psychiatric hospital, responding to bleeps and starting some revision for this summer's exam. It is through my own loss of the Mass on this day, as I work the 12-hour shift, that I most sharply experience Lent. My work, a burden at weekends, can be offered up as I watch the Holy Sacrifice on my iPod!

Please remember to make your UK response to the

RCPsych's draft consultation to the DoH's investigation into the effects of Induced abortion on mental health.

Studies vary in their conclusions, and with regards validity; but some find Abortions are harmful, in it's resultant mental health. But other studies find that women have just as many psychological problems following birth of an unwanted pregnancy.

But NONE of them would have the legal effect of justifying the Abortion legislation; 97% cases being performed on the grounds of avoiding mental and physical health problems which continuing to birth would cause. The only kind of evidence the DoH should be satisfied with, is a demonstrable better mental and physical health in the abortion group. This draft publication and literature review clearly do not show this.

Therefore the very basis of the clause in the law should be closely examined and hopefully removed, which would eliminate 'abortion on demand' and at least result in the consent counseling including that any women susceptible to mental health problems are at increased risk of developing 'post-Abortion syndrome'.

This, paradoxically, (perhaps poetic irony) nullifies the rationale of 97% of the use of the 1967 Act.

Saturday, 19 March 2011

Sidcup Healthcare Conference

Our Lady of the Rosary is hosting a spiritual and learning conference built upon faith and clinical excellence for healthcare workers, arranged by the Catholic Medical Association (Kent Branch.)

The Conference will take place on Saturday 19 & Sunday 20 March 2011. for medical professions, this will gain 6 hours of CPD: Certificates of attendance will be available.

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