Sunday, February 03, 2008

Juggling Brains

The always amazing bongi (I could also characterize him as shiftless, but not everyone would get it) has a post that led me to think about how doctors juggle patients in their brains, and how bizarre it is. The need to switch gears rapidly and completely among clients, customers, or patrons of one sort or another surely isn't unique to physicians. It's just that, given the stakes, with docs it might be the most jarring and otherworldly.

I've always tried to be mindful of -- and here I'm just making up a term -- "disproportionate impression." I walk into a patient's hospital room, or see someone in my office, and it may well be the most important and impactful minutes of that person's day. For me, it's one of many similar encounters, some pretty routine, others of horrendous import. I'm the only surgeon each patient has; each is but one of many for me. My words and reactions likely reverberate in each room for hours or days; but I must move on and reset my brain in a blink. Therein is the unworldly aspect of it: I can't, but I do. I mustn't, and I must.

"Minor surgery," it's said, "is surgery done on someone else." Seeing a surgeon is a big deal, whether for removing a harmless lump, fixing a hernia, or taking out half an esophagus. Everyone deserves a full measure of my attention. If I'm despondent over a patient dying in the ICU, or have a bunch of operations pending later, or am feeling like God's gift to surgery because of some tricky procedure done well, I have to attend properly to the person in front of me. To give a young woman news of her cancer, as bongi wrote, and only a moment later to see a routine post-op, or speak hernia. I guess that's what is meant by "compartmentalizing." I can't quite figure out if it's a good or a bad thing to be able to do it.

In my book, I wrote:

"There are times when I’ve thought that having been inside people’s bellies, touching them more intimately than they’ve ever been touched, knowing things about them that they’ll never know themselves—seeing their liver ferchrissakes!—I ought to stay at their bedside for every minute of every day they remain the hospital. Maybe take them home with me..."

I wasn't kidding. It's such a cataclysmic thing, operating. How can you operate on a person and just move on to the next case? It seems, to paraphrase and borrow from myself, "disproportionate attention." But it's obvious we need to; and somehow, in the process, we must not shortchange anyone. Including ourselves. I can handle it during the day. I just wish it could be turned off when pulling up the covers for the night, which is when the compartments seem to break down.

[P.S: For those of you who noticed and are wondering, I put up a video twice this weekend, and finally took it down because the video, about Barack Obama, kept becoming "unavailable." No hidden meaning to the disappearance, other than frustration.]


Bongi said...

thank you for your kind words. you beautifully bring across what i was trying to say. obviously a surgeon would understand.

maybe it it time to post on shift workers, the bane of our existance.

rlbates said...

Lovely post, Dr Sid. I have "planned" or "reviewed" what the next day's operation would be many nights. You are so right--we take them home with us. I laughing call my patients "my little chicks" but often I feel like a mother hen worrying about them.

Anonymous said...

My husband is in his chief resident year in general surgery. Yeah!!! I've seen him many times with this look on his face. It's always "sorry just thinking about something". Sometimes when I try to wake him to go to bed he starts asking me what lab, ultrasound, etc. showed. So, I just call his pager, put it to his ear, then he wakes up, and I tell him to go to bed! We've had a lot of good laughs. I do understand to some degree of "reviewing the day" or "planning the day ahead" as I am a former child protective service worker. I've spent many nights wide awake. I learned to put a notepad on my nightstand to write down my "checklist". What can I do to help my husband put the day to rest?

Not Important said...

Dr. Schwab,

Based on my experience in Corporate America(TM) it's not unique to surgeons, but I imagine that it's much more intense in medicine.

OT, but recent - my doctor told me that she enjoyed our doctor/patient relationship. It made my morning.

Sid Schwab said...

Gdad: and well it should have, after your recent episode.

Tea N. Crumpet said...

Great, insightful post! I used to be in social work-- the world is crazy, save yourself!

I'll be buying your book. It should be sitting in doctor's offices. . .

Justine Johnston Hemmestad said...

What a Beautiful post, Dr. Schwab, and in regard to your "p.s.," here's a link (or address):


Moving this post to the head of the list, I present a recently expanded sampling of what this blog has been about. Occasional rant aside, i...