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Tuesday, September 2, 2014

Why Hospitals and Surgeons are Sometimes Suspect

The Local Lens

• Wed, Aug 27, 2014

By Thom Nickels

While hospitals are generally places for healing, sometimes—unfortunately-- the reverse is true.

An older woman friend of mine, for instance, talked about a lung biopsy she underwent in a large Center City mega hospital. For quite a while this friend had been having disagreements with her doctor on whether to remove half her lung or to treat her condition with antibiotics. Having half your lung removed is a life altering procedure, so there should be an iron clad reason for doing so. My friend felt that her doctor didn’t have a good enough reason for removing half her lung, so she kept telling him no thank you. In addition, she felt he was far too ‘knife happy,’ almost as if opening the human body and removing organs had become his obsession. In one instance, the knife happy surgeon even told her, "I’m going to get your lung one of these days!" as if he were a vampire or a ghoul.

Life occasionally takes unexpected turns, and that’s what happened when my friend underwent a lung biopsy by the surgeon in question. Now, a biopsy is just a mission in search of a tissue sample, nothing more, so the idea of it didn’t seem complicated until someone in the operating room made a mistake. During the biopsy, the surgeon, or his accompanying resident, nicked her lung, meaning that another surgical procedure was needed to fix the problem.

The operating room team knew about the nicked lung at the conclusion of the operation because they wrote specific instructions on the patient’s chart that she was not to have any solid food because another procedure was immediately pending.

Do you think the floor staff read the doctor’s instructions? My friend was fed solid food, and as a result she could not be given an anesthetic for the second go-round but instead had to endure the feeling of a surgical knife cutting into her skin and into the skin’s deeper sub strata layers so that they could uncoil a tube inside her.
The flimsy local anesthesia that she did receive did nothing to mask the pain caused by the deep digging surgical knives.

My friend described the pain as "unbearable."

But her odyssey didn’t end there. Once the procedure was over, she told me that she wasn’t given enough pain medication, and that she had started to bleed all over the sheets. When she rang for a nurse to change the sheets and also to request more pain medication, nobody came. She waited for a time and rang again, but the response was still the same—nothing. Finally, after giving it one more shot (she pressed down hard on the call button this time), she disconnected herself from a wire holding her to the bed and walked to the nursing station herself, a sight for sore eyes in her bloody hospital Johnny.

Once at the nursing station she let the little circle of telephone yapping-folder filing personnel, have it.
I will not repeat here what she said, except to say that the thunder and verve of her scolding got results fast. Suddenly, the nurses couldn’t do enough for her. Would she like to be escorted back to her room in a wheelchair? Would she like a Krispy Crème donut? And yes, her bed sheets would be changed immediately.

Later, a nurse appeared at her bedside, practically in tears, apologizing for the neglect of the general staff and telling her that she would report the neglect to the floor supervisor. "This is awful, really awful," the good nurse kept saying. "I’m so sorry. Heads will roll!"

The hospital in question is a big city hospital. I remember this hospital from childhood, because a classmate of mine in the 8th grade died there.

His name was Richard H., and he died of a brain tumor after being sick for what seemed like a short while. The tumor came on quickly. Richard had several surgeries, would come back to school with his head in bandages-- on the road to recovery, we thought-- but then in no time he’d be sent back to this hospital. One morning, Sister Immaculata, our teacher, announced that Richard had died. His High Solemn Requiem Mass was one of the saddest experiences of my childhood.

While I’m sure that the big city hospital in question was a much better place years ago, it’s almost a certainty that long time employees there even at that time suffered from the same condition that’s prevalent among hospital personnel today: occasional bouts of medical callousness.

Like it or not, a basic callousness to human suffering comes from working in a hospital environment for too long a time. Hospital workers may not even be aware of what has happened to them in this regard, either.

During my time as an operating room orderly at age 21, I witnessed many things: Nuero- surgeons talking about their weekend golf outings as they drilled through a patient’s skull, or as they dug deep with gloved hands into a man or woman’s abdomen. Some surgeons were like temperamental opera divas or restaurant chefs. If an action of a scrub nurse displeased them, they might throw a set of forceps across the room, or kick one of the floor waste buckets (they were on wheels) so that it went rolling across the room and slammed into a portable X-ray machine. Other surgeons screamed that they wanted "Nurse so-and-so to get the hell out." Sometimes the surgeon in question would walk out of the room himself (there were only a few female surgeons, but only the males had problems with their temper). I don’t know whether this "walking off stage" ever put a patient’s life in jeopardy. My guess is that most often it did not because there was always a resident (in scrubs) ready to take over when a surgeon misbehaved. Residents, in fact, were almost always on hand to observe and then, when asked, try doing the operation themselves.

During most operations, the surgeon would do the opening incision and then maybe stick around for a few exploratory "digs," but once the work became "mechanical," an assistant would take over. The surgeon almost never hung around as the patient was being stitched up before the transfer into the recovery room. At this point they were already in the surgeon’s lounge or in the small doctor’s lounge having a cup of coffee and eating a sticky bun.

The stresses of meeting the demands of diva surgeons meant that many scrub nurses were ready for a laugh, and this sometimes took a bawdy turn, such as when a nurse or two would steal a peek under the cover sheet when an especially good looking young man was fast asleep on the operating room table. While these were very unethical peeping tom moments, I witnessed their occurrence time and time again and wondered what the guy who was being looked at would do or say if he knew what was happening.

As an OR orderly, I was expected to open all the operating rooms at 6:30 AM, set up the IV stands in the individual curtained cubicles and retrieve the patients for 8 AM surgery from the hospital’s upper floors. It was a huge responsibility. If an OR orderly was squeamish about blood and guts, there were only two options available: quit, or find a way to get used to the gore.

My job included taking specimens to pathology, including aborted fetuses from the many therapeutic abortions preformed at the hospital. As a twenty year old I didn’t give too much thought about these procedures. I naively assumed that the abortions were performed to save the life of the mother until I got talking to an Eastern Orthodox nurse who said that this was not the case at all. She also told me that she was on record as refusing to assist in these "therapeutic acts of murder." While I admired her for having the courage of her convictions, it made me wonder about all the Irish Catholic nurses (this was Boston, after all) who didn’t seem to have any issues with abortion, but who would look very, very distressed when handing me the little fetus jars to take to pathology.

These quick, guilt-ridden "exchanges" reminded me of Pontius Pilate washing his hands of the situation.
Mastectomies and amputations affected me the most, especially when a scrub nurse would put a still warm, wrapped in blue linen amputated leg in my arms, and ask me to deliver it to the morgue.

Of course, when a patient died on the operating room table, the mood in the room turned solemn. Many scrub nurses became upset. Some actually cried. The nurses were the ones who felt a death the most. The surgeons, for the most part, were stoned faced. It was hard to know what they were feeling. It was always the nurse or the orderlies who stayed behind and cleaned up the room and washed the body of the deceased. For me, a death in the OR was always a shock, especially if I was the one who had escorted the patient to the operating room earlier. Times like this, I’d think back and try to remember if the patient had said anything of note, or whether their behavior pointed to a premonition regarding their own death.

After the washing of the deceased’s body, an orderly’s help was needed in moving the man or woman onto a special stretcher for the trip to the morgue. The silence in the OR room at this time was profound. People spoke only if necessary. There was certainly no talk of golf, or how great it would be to get drunk at the after work happy hour at the local pub.

Wheeling the stretcher with the covered up corpse on it to the elevator nearest the operating room, and then getting to the basement morgue without anybody else coming on the elevator was hardly a guarantee. There’d be no emotional reaction if a nurse, doctor or resident got on the elevator at different floors, but if a non-medical visitor to the hospital saw the stretcher, he or she would step back as the blood would seem to drain from their faces.

In conclusion, I’d say that long time hospital experience can either plunge you into a river of callousness, from which it may be difficult to return, or it can work to increase your human empathy skills. I don’t know where into which category I fall. I like to think it’s the latter, but who knows.

Decades after my job in the OR, I still have dreams of wheeling stretchers down long antiseptic corridors and of bumping into surgeons in masks, who may or may not be holding a pair of forceps.