Saturday, February 10, 2007

Windy Beneath the Wings

People are strange. For the life of me, there's one thing (right: only one!) I could never figure out. As I said in a recent post, I made a major effort to gain patients' confidence, and to have them approach their operations with a positive attitude. With hardly an exception, they'd leave my office in a good frame of mind. Mostly, they'd show up for surgery the same way. But not always. There was that damn Uncle Joe, or the neighbor Alice, or good friend Betty. What the hell were they thinking?

"Joe/Alice/Betty told me he/she/she knew someone who had (insert any operation you can think of) and (insert horror story here.)" Died. Couldn't walk. Woke up left-handed. Turned green. It's mystifying. Were they trying to help? To show off their knowledge? Were they deliberately trying to scare the shit out of them? What, ran out of small talk? Why would anyone do that to someone, right before they're going to the hospital? Nuts. And it's not at all uncommon. What ever happened to "good luck?" Be thinkin' of you. More like, guess you won't be needing that car no more? 'N I have it? With friends like these....

The only thing more annoying is the person who accompanies a patient to the initial consult and who has to make the encounter about him/herself instead of the party of the first part. "Yeah, I had sompin' like that. Worse, really... damn near lost my leg/colon/life/sense of proportion. It started about ten years ago. Got a minute?...."


alwaysthegoodgirl said...


Anonymous said...

In my particular case (debulking for ovarian cancer), it was some nitwit relative who assured me that "the minute they open you up, all they do is spread the cancer all over your body. Once they cut you, you'll be dead in months."

Of course, I had spent the last 40-odd years of my life being assured by the same nitwits that if you put your money in a bank, it will be stolen by the Illuminati, so I did not, actually, begin to doubt what my surgeon had told me. Nor did I, actually, take it as intentional callousness. I just have relatives that I avoid, in good times and in bad.

That fact has, actually, caused me more trouble with ongoing consults with my oncologists. I am adamant about not allowing family members in the exam room or the consult room. I will rarely let them into the waiting room. I made a mistake in that direction before surgery, and I'll not do it again. But because I ended up with a new doctor, who had no prior experience of my family, I found myself getting interrogated all the time about depression, was I isolating myself, is there someone who could come with me, etc. I finally had to explain in graphic detail what had happened the last time my mother and sister were present for the consult, and ask the doc if she really wanted to go through that. She admitted that she did not, now I put it that way.

Of course I was touched and impressed that my doc wanted to include my family and was concerned that I might be isolated. It just produced an odd kind of gallows humor in my case: the doc thinks I must be socially isolated, I think the doc must be a real masochist.

Anonymous said...

Lost my sense of proportion?!


Anonymous said...

I think it depends on the kind of surgery you are having. There comes a time when it is what it is and as the patient, you must trust in your decision, your team, close your eyes, pray, put a blind fold on and jump in feet first. Otherwise, no one in their right mind would do certain things. I think as a patient, it's their responsibilty to shrug off certain comments or just not tell certain people of their procedures. In the xplant center, there is this unwritten rule, we ask sometimes, if it's not obvious what's wrong, and we give the short, one line answer and everyone hugs and says good luck with that. It's funny to me though, because I have seen people go in for hernias and they sign a dnr and totally freak out. I think you have to use caution whom you share things with and when you open your mouth, you should be prepared to hear whatever comes out of the other person's mouth.

Anonymous said...

kathleen, I can't tell you how much I wish I could hide my problem from other people, because I would. If I could get people to believe that one day I just decided to start wearing a wig, shave off my eyebrows, lose 20% of my body weight, and start wandering the supermarket in a surgical mask, just for the hell of it, I'd let them think I'm more than a little eccentric. Or that I just have a bad cold that took a turn for the worse. I'd prefer that to complete strangers coming up to me and sharing information about the last miracle cure they read about on the internet. I actually had some lady try to put carrot juice in my cart, because she'd read that carrot juice can cure cancer. This did not happen because I told anyone anything. It happened because the world is full of nitwits and I am not willing to lock myself in my own room and stay out of the grocery store to prevent people from seeing that either I have cancer or I'm on my way to a chemo-themed costume party, whatever you think is most likely.

Anonymous said...

I think the message in your post is so important for everyone in the medical field to know. Lives could be saved and better outcomes could be had with positive attitudes. An excellent surgeon, I truly believe, is also in part psyciatrist, in that the surgeon knows the significance of what is going on in the patient's head and heart before surgery, and knows how vital those emotions are to the outcome of surgery. The surgeon's attitude is also infectious to the patient.

ERnursey said...

Can you get sued for malpractice if your patient loses their 'sense of proportion?'LOL

Cathy said...

LOL...I am not laughing at this post but rather how exact it is. It happens every single time one is getting ready to have surgery. And, it seems the bigger and more radical the surgery the more these horror stories are told.

Prior to my cancer surgery when I was still trying to decide between radiation (5x weekly x 6weeks + 72 hr. Implant) and radical surgery I heard many of these horror stories.I even had a "concerned" uncle who felt some need to tell me that so and so from his neighborhood, had the same type cancer I had, and was treated by the same Doc I had...."You do know that she ended up dying, don't ya?"

Back years ago when you were admitted to the hosp. the night before any surgery, they used different pre-op meds than what they do today. I had the worst experience ever.

I have no idea what it was they put in my IV, but it was some kind of med that made me appear asleep, but I really wasn't. I couldn't talk or respond, but I was aware of what was going on and my hearing was fine. My family, believing I was sound asleep, was having quite the conversation among themselves. OMG, If I could have gotten up from that bed I would have ran as fast as possible from that hospital. I was totally petrified by the time they took me to surgery. I have never understood why people feel a need to do this. It is cruel beyond belief.

Eric, AKA The Pragmatic Caregiver said...

anonymous, I'm dying to know what is served at a chemo-themed costume party....ginger ale? dry toast? soda crackers? When people say they're gonna get "partied up", do they have a Zofran-and-soda? Are the parties held with the same menu one morning, every two weeks, for six to eight weeks?, then a change of menus and a repeat of the cycle?

One of the most glaring intrusions occurred to me recently at Wal-Mart. I was in the "absorbent products" section stocking up for my father-in-law, when this woman came up to me in that sotto voce "confidential" voice and said that I was "too young" to need "all this", and that I should get some of these herbal things she takes for the problem. I was *SO* flabbergasted, the only snarky comment I could come up with was "It's not because I need them, it's because I like them!". Pity it didn't happen three weeks later - I could have said I was an astronaut!


Greg P said...

To some extent, I worry more when people unquestioningly agree to something. Some won't even let you explain, they keep interrupting with, "Whatever you say, Doc, I'll go ahead with it."

But I do wonder about these "friends" that tell horror stories to scare people unnecessarily. Where the hell are they coming from?

SeaSpray said...

Unadulterated ignorance! What other explanation could there be?

I have never encountered that and I really don't think I will with my usual circle of friends and family. My doctors have been great and very, very patient with the patient. :) They have all been wonderful.

I have been blessed with a good support system. If anything, I have been the one to give in to fear. However, I have recently resolved within myself that I am going to press forward and do whatever I need to do for myself and I am believing for a good outcome! :)

Anonymous said...

eric, I pretty much stick to the Compazine-and-steroids combo plate garnished with 325mg of iron and a few sprinkles of those pretty pink Benadryls. Guests can eat anything they can spear on a Huber needle.

I suppose it isn't all bad. A young relative of mine caught a glimpse of my mediport one warm day when I just had to unbutton the top button of my blouse. Afterwards, I was informed, he had been overheard to express some awed admiration for Aunt Anonymous's major hickey. I do not, actually, deserve this reputation for hickeyness, but I'll take it.

What this is all about, in my view, is mostly the same thing that any "rubbernecking" is about. Some people cannot resist inserting themselves into a conversation in which they have no business because it's ghoulish and they find that entertaining.

View from the Trekant said...

Excellent post.

I'm amazed at the folks who accompany a friend or family member to a planned cardiac cath so they can tell me that they 'know someone who died on the table' having a coronary angiogram.

This is a really rare event, so it's fun to make this helpful person give the specifics of the case 'they know.' Always turns out to be something else:

*Patient died in the throes of an acute MI.
*They don't really know anyone who died having a heart cath, but they know someone who knows someone who THINKS they know someone who did.
*They describe the death of a family member than occured before coronary angiograms were even invented or in general use.

Can't blame the 'lay public' too much - The worst are other health service employees who feel obligated to look like they know more than they really do about your subspecialty and feel that they best express their expertise by making negative and accusatory comments.

Destroying a patient's trust and relationship with her physician and care team when there is no real evidence that it is necessary . . . . evil, in my opinion.

Echo Doc

Anonymous said...

oh, god, why do people do that?? i had to go in for a very minor "surgery" because two of my teeth weren't coming down (i'm a teenager) and everyone around me - even, yes, my uncle - had horror stories of their own to share.

and all i could say was, "sorry, but this is helping me how exactly?"

Anonymous said...

very true. i once saw me a doctor. he gave me pills, next day i went crazy. true story. better to eat mushrooms in woods and such, i always said.

Unknown said...

I was wondering if you had read the results from the ACPE Physician Morale Survey. It cites that nearly 60% of surveyed doctors have considered leaving the practice of medicine because they're discouraged over the state of US health care today. The top 5 contributing factors contributing to low morale were identified as low reimbursement, loss of autonomy, bureaucratic red tape, patient overload, and loss of respect. Are these reversible?
It seems that you've touched on a number of those issues individually, but I was hoping we might get treated to a post that ties all of those issues together. As a student applying to medical school and who wants to be a surgeon, I'm especially interested.

Sid Schwab said...

Taylor: a very challenging subject, since I'm one who fizzled sooner than I'd have predicted years earlier. It's an important topic, which will require a bit of time and rumination. I'll work on it. Thanks for the suggestion.

SeaSpray said...

Dr. Schwab - Do people usually put their own blood in the blood bank in anticipation of certain types of surgery? (someone recently brought this to my attention)

Is the blood supply safer than it had been some years back? I thought that they have better ways to screen the blood now and that it's not the concern it had been.

How much time is needed prior to surgery to do this?

Of all the questions I did ask my doctor, it never occurred to me to ask this one.

Sid Schwab said...

seaspray: banking one's own blood is done fairly commonly, depending on the operation and one's general health. And, of course, the recommendation of the surgeon. Usually it's just one unit; sometimes two can be done, spaced apart; generally around two weeks ahead of surgery, plus or minus. And yes, I consider banked blood very safe nowadays: there are various tests done for various diseases, and most blood is provided by repeated volunteer donors.

SeaSpray said...

Thank you Dr. Schwab :)

Anonymous said...

I have been thinking about this behavioral phenomenon and while I wonder if I am guilty of doing the same I know for sure that I have done the opposite: that is, minimized the risks of certain surgeries when it was apparent that the patient wanted to address the seriousness of the upcoming event and confront the fears that naturally accompanies thoughts of the unknown.

And I also have to say that those in the health field are not immune to this sub-type of this behaviour themselves: I tend to call it self-promotion via war stories. I have noticed that when certain professions meet socially or professionally the conversation seems to degenerate into a who-took-care-of-the-most-serious or -unusual-cases, regardless of the outcome type of sparring contest; always trying to "trump" the previous story's "gross" factor.

I wonder if these two behaviors are the manifestations of the same human response to the subconscious fear that it could be us in that scary situation instead of the relative / patient: one trying to exaggerate it, the other minimizing or belittling it. Both possibly some kind of weird defense mechanism?

Anonymous said...

People always feel like they have to tell a first-time pregnant woman all sorts of scary birth stories they heard about. It's sick.

Anonymous said...

Dear anonymous, What I meant by hiding your disease, is this. I had a drain tube for a long time. I named him "Marvin". I bought him "clothes". I used jewelry pouches to stuff him in . Some beaded, some organza, some velvet. I was also super thin. I had hair, but it was nasty. I was manurished to say the least. When people commented on Marvin, and they alwsys did, I said, hey, your just jelous, I paid a lot of money for, it's the latest in body jewelry. You can get one too for 100,000. I filed my shopping cart with jello, bottled water, fat free pudding and laundry soap. I would say IO was a petitie runway model or on a starvation diet to raise animal cruality awareness. That's what I meant by hiding it. You are not compelled to share your business with people just because they can not mind their own. I hope this helps


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