Monday, March 24, 2008

Fact is stranger than fiction

    The endless parade of interesting, fascinating and odd characters with whom one interacts in this profession could literally provide fodder for a soap opera series. I find human behavior riveting. I might have been a psychiatrist but for one failing. As much as I like listening (which is a prerequisite for psychiatry), I just love talking. And in my anesthetized patients I have found a captive audience who can not interrupt me. The surgeons also make an appropriate audience because they aren’t going anywhere. The only drawback is that surgeons sometimes talk back (if they don’t know what’s good for them). I have a reputation for a passable sense of humor and use it to diffuse some of the tension in the OR. My wife, on the other hand, has no sense of humor as I have pointed out to her frequently. She, however, always makes the relevant point that she did marry me after all. I have yet to come up with an appropriate retort for that one.
     So, back to the patients. One night, after finishing the last of several urgent operations, I received a phone call from a very, very, very, very junior surgical resident (meaning: he started his residency that month). He was concerned about one of the patients who had undergone an emergency appendectomy earlier. He said, “The patient isn’t moving.” I then suggested, “Pronounce his death and let me get some rest for God’s sake.” “No,” he said, “it’s not that, he’s alive, he’s just not responding to me.” I thought to myself, “If I were your patient, and if I knew that you were the most inexperienced doctor in the hospital, I wouldn’t respond to you either.” No, I’m not that mean spirited, I didn’t actually say that to him, but I do get cranky at 3:30 AM when I haven’t gotten my beauty rest. “Oh, alright, I’ll be right up.
     I had not been involved with that particular patient’s anesthetic, so I asked the doctor who had, to meet me on the surgical ward. I found the resident and asked him to show me to the gentleman in question. I found a young Bedouin man lying in bed staring at the ceiling with his mouth open. After noting his normal breathing and skin color, I just had to have some fun with the resident (after all, it was 3:30 in the blessed AM). “Are you sure he’s not dead? He looks dead to me, did you take a pulse, did you measure his blood pressure, and have you informed the next of kin?” The look of abject failure made me feel sorry for the kid. “Don’t get yourself in a fit. He’s alive, I’m pretty sure of that. Now watch and learn.”
     “Ahmed, I’m Dr. ____. How are you feeling?”
     No response.
     “Is his name Ahmed?” I asked the resident.
     “No, it’s Faiz (not his real name to protect the patient’s privacy).” He replied.
     “Well, the first lesson is to always address the patient with his correct name.”
     “Faiz, can you hear me?”
     No response.
     I took Faiz’s hand and held it over his face. Faiz held his hand in the same position until I returned it to his side. Then, I positioned his other hand straight up, and again he held the position. When I bent the elbow, Faiz looked as if he were reading a menu in bed. Turning to the resident, “Do you understand what you have just witnessed?” I saw a complete blank on the resident’s face, but to save face he replied in the affirmative. “Don’t worry, you don’t have to know everything in your first week. It’s called catalepsy, look it up. It might be a reaction to the stress of being hospitalized and operated on.”
     “Call for a psych consult if you want. It’s not an anesthetic complication. It’ll probably pass in couple of hours anyway.” At this the nurse in charge of the shift got her hackles all up in a frenzy. “You take him back to recovery, it is an anesthetic complication. We sent you a perfectly fit patient to the OR and this is how you sent him back?”
     “OK, cool your jets, he left recovery completely conscious. There is no reason to move him back down to recovery.” I will spare the reader the barrage of epithets, threats, histrionics and general mayhem flung in my general direction. By this time the rest of the shift nurses were ganging up on me. I called for back up, “bring the senior surgeon on call here and let him decide.” He did, and it was not to the nurse’s liking. “I’ve been a nurse for 20 years and I’ve never seen anything like it.”
     “Just because you’ve never seen this phenomenon doesn’t mean it doesn’t exist.” I replied.
     This assault on her professionalism just inflamed the situation and I was subjected to another barrage of what she thought of me. I just don’t know when to shut up (but that’s why I went into anesthesiology in the first place remember?) Let’s just say that I was no longer her favorite anesthesiologist and leave it at that. “I’m standing firm by my decision. Call psych if you want. I’m going to sleep. Good night.”
     When morning came around, I groggily called the senior surgeon to ask about the patient. They had called for a psych consult, but by the time the psychiatrist had reached the ward, the patient returned to his normal state (which was apparently not so normal, as the surgeon confessed, that the patient had been hospitalized for a week with no diagnosis and had been acting strangely. The appendectomy was performed as a last resort because of increasing abdominal pain and no other obvious diagnosis. The said appendix was, as to be expected, completely normal.)



Lioness said...

This is slaying me, what was wrong with him?? We'll never know will we, we will never ever EVER know and it will gnaw at me for the rest of my life.

I'll make such a well-adjusted vet, wouldn't you say?

Unknown said...

Lioness - I think you'll make a wonderful vet as long as your patients aren't cataleptic :)
As far as what was wrong with him, the surgeons told me that he acted very odd during the hospitalization. Complaining of abdominal pain with very inconsistent findings upon physical examination. He was histrionic at times and I think (and I'm NOT a psychiatrist, so take this with a grain of salt) the episode climaxed with a very dramatic outcome - a laparotomy. So his catalepsy was just another facet of his abnormal behavior.

Lioness said...

Bizarre. As for me, I know me well enough to be fully aware that all those animals I'll encounter for whom we'll never have a diagnosis will frustrate me to no end - especially if they don't get better. That's one of my certainties. My other one is, I will want to throttle owners more often than is good for one's BP and psyche. Just you wait.

Jack Steiner said...

A junior surgical resident is never going to be allowed to "practice" on me. That is downright frightening.

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