Wednesday, November 12, 2008

That Really Bugs Me

The hours are long, the commute is long, but I'm very pleased with this hospital. The work load is tremendous, almost impossible. But there is a very positive atmosphere. Although there are things that I prefer about my previous hospital, there are things here which make the work much more enjoyable. There is much support in the the small tasks in the OR that together add up to more than the sum of their parts. In general the running of the OR is much more efficient. In my previous place of employment, besides anesthetizing the patient, at the end of surgery I would bring the patient to the PACU (Post Anesthesia Care Unit aka recovery) and have to personally inject all the iv meds that I ordered for the patient. Then, run back to the OR and prepare the equipment for the next case.

In this OR, the PACU nurses perform all the tasks ordered by the anesthesiologist without the anesthesiologist being physically present. During this time there is the support staff that prepare the OR for the next case. This means that I have more time to be a doctor and just be with the patients. I actually have the time to talk to them. In addition to medical history and physical examination, I have the time to actually get to know the patients, even superficially. Surprisingly, I've discovered that most patients have jobs! Last week I anesthetized a dancer with a broken leg. Today I anesthetized a composer. We had a lengthy and fascinating conversation about the Israeli jazz scene (jazz is one of my passions).

Not surprisingly, these short exchanges calm the patients as much as, if not more than, iv anxiolytics. One can't feign interest, the patients respond to someone who sees them as people and not as "cases". Even the brief interaction between a patient and the anesthesiologist can be meaningful. This is all the more intense when the patient is faced with life altering events...

...The operation should have been scheduled for the morning when everyone is fresh. But all the rooms were booked which means that the operation would be postponed for another day. The parents were red-eyed from crying. They brought their young child to the hospital because of generalized weakness. The diagnosis: a brain tumor in the posterior fossa, which involves a particularly difficult operation fraught with danger. The most senior anesthesiologist on call took the case while the rest of us continued with the "regular" emergency operations. Working through the night, at 7 AM the child was transported to the pediatric ICU. I can only imagine the turmoil the parents went through. Their previously healthy child was diagnosed with a life threatening tumor and within hours underwent uneventful surgery.

This story will most probably never be reported in the newspapers. There is a "journalist" in one of Israel's dailies who has made a career of "exposing" malpractice. Obviously, I don't condone malpractice. But this evil man, by twisting the truth has ruined careers, all to sell a few rags. His vitriolic articles spew hatred for doctors and the medical system. Perhaps he or a family member were victims of malpractice. Some say he has a chip on his shoulder because he wasn't accepted into medical school. Whatever the reason, he writes negative articles exclusively. To be sure, there is malpractice, most often it can be attributed to the insane pressure of an impossibly overworked system. He will never write about the good things we do on a daily basis. That really bugs me.


Carol Feldman said...

First, I always enjoy reading you!
Second, your mentioning "having time to get to know the patient" really struck a cord with me.

My daughter (19) had to have her tonsils removed a couple of weeks ago. She wasn't apprehensive about the surgery, the recovery or pain, she was terrified about the anesthesiologist hitting her vocal cords. She is a classical singer and this is her love and life.

At the very last minute, the anesthesiologist she had never met before came in to have her sign forms. When she tried to talk to him about her concern, he told her he could guarantee nothing, with no attempt to calm her fears. In fact, he and the rest of the staff laughed when she began to cry and proceeded on.

I wish you had been her doctor!

QuietusLeo said...

Carol thank you for you kind comment. It's very disconcerting for me to hear of such lack of compassion among medical staff.
BTW, I absolutely love your watercolors, especially the cow! (I milked my way through med school and have a special place in my heart for those of the bovine persuasion.)

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