Friday, November 23, 2007

The Clinic

The routine of the OR is sometimes broken when I am assigned to the pre-op clinic. The main purpose of the clinic is to prevent last minute cancellations of operations. These cancellations usually occur when a patient with a chronic illness, such as heart disease, arrives on the day of the operation in less than optimal condition. An example of this might be uncontrolled blood pressure on the day of the operation. Such a patient's surgery is cancelled and the patient is usually referred to the family physician to reassess the patient. This results in inefficient utilization of the OR and causes frustration for the patient who may have waited quite a long time for his/her surgery. Such a patient would be identified in the pre-op clinic and sent to the appropriate referral.
The clinic is sometimes very hectic with over 40 patients per day. I salute family physicians who deal with this case load on a daily basis. For me, it's enough twice or thrice a month. I guess I need the daily adrenaline rush of an emergency case to keep me on my toes. On the other hand, having an opportunity to interact with patients at eye level (not lying on a stretcher) is a refreshing change.
One might call the clinic a parade of endless variety. Human nature never ceases to amaze me. For example, a pretty young woman came in to the pre-op check-up prior to a gastric banding procedure. This was to be her fifth procedure. The previous four surgeries had been complicated by slippage of the band, perforation of the stomach and more. I was floored when she said that the thought of another anesthetic scared her to death. She was looking for reassurance. I told her that she should rely on her experience; all the complications she suffered were surgery related, none were related to anesthesia. Besides, modern anesthesia is safer than ever (kind of like air travel, isn't that reassuring?).
I'm always surprised by the question: "doc, will I wake up at the end of surgery?" I always think to myself, "and if not, what, you're going to know about it?" No, I don't ever actually say that to a patient, I always reassure them that I have a 100% wake up rate. The fact that someone is planning on cutting into one's flesh is less frightening to some than the anesthetic. Apparently, this fear is really the fear of loss of control over one's body, of one's autonomy. This perhaps, is the only real freedom one is granted by nature. To willingly surrender one's autonomy to a total stranger is a frightening prospect, and this explains why many of the patients ask if I will be their anesthesiologist for the surgery. I humbly submit that this question has less to do with the patient's impression of my professional ability, and more with the simple need to see a familiar face in unfamiliar surroundings.
Despite the case load, I make a point to counsel smokers about the need to quit smoking. It is somewhat of a personal crusade, I admit it. I hate cigarettes, no, not hate, despise. I always have, even as a child, I refused to allow smokers into my room, even if they weren't smoking at the time (because of the accompanying stench). Ironically, I'm an ex smoker myself. I started, like many, before I grew a brain, during my army service. Sometime after the age of 30, my brain grew in. I haven't touched a cigarette in six years. I unabashedly use myself as testament to the fact that it can be done. The counseling only takes 5 minutes, and usually something I say convinces the patient to at least try to quit. The mini-lecture includes the cumulative adverse effects on body function, the connection to systemic diseases such as heart disease, lung disease and high blood pressure. Smoking causes cancer, not one kind, several different kinds. Cigarette smoke just plain stinks, it stinks up the house, the clothes, the hair. Those that smoke in the home endanger their children as well. There was one young woman who didn't seem convinced by any of it. The look on her face was one of utter boredom. I asked her, "doesn't any of this make sense?" She answered, "It all sounds logical, but I just like to smoke. It's as simple as that. I don't want to stop." I told her, "Maybe not now, but every smoker I've ever known reached the point where they wanted to stop, but couldn't." I didn't seem to make any impression on her. But then, I said something which touched a nerve. Everyone has a weakness, a soft underbelly as it were. I said, "If all this doesn't impress you than I want to say one more sentence: It is unaesthetic to smoke. A pretty woman or handsome man who puts the death stick in their mouth is just plain ugly." At this point, she burst out in tears. Of all the logical arguments that I put forth to quit smoking, none made a dent in her fa├žade. Only by appealing to her vanity was I able to get through to her. Yes, human nature at work ladies and gentlemen.
The last patient of the day was a kind grandmother of 12 who was born in Morocco. I mention her birthplace only to explain that Moroccans have a great tradition of hospitality which includes excellent food. While taking her medical history, she suddenly pulled a plastic bag out of her purse. The bag was filled with Moroccan cookies and pastries. "Here", she said, "taste." Along with a proud tradition of hospitality is an equally important ability to be mortally insulted if that hospitality is rejected. Out of politeness, I tasted a cookie, commented on how sweet it was and handed back the bag. "No" she said, "you take the whole bag." Either she had another 12 bags of cookies for each of her grandchildren or she was impressed by my charming personality. I didn't dare refuse.

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