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:



1 comment:

ChrisDar said...

Pretty. This has been a wonderful post. Many thanks dadwithnoisykids.

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