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Volume 1, Issue 1
Spring 2005:

Some Doctors Are From Saturn

June Bingham

Cell 2 Soul. 2005 Spring; 1(1):a9

Some adults can't remember what it was like to be a child; likewise, some doctors can't envision how it feels to be a patient.

The result is that such physicians don't learn how to communicate effectively with their patients. If men are from Mars and women from Venus, then these doctors must be from Saturn.

The dictionary defines saturnine as one given to a surly disposition; taciturn: temperamentally disinclined to talk.

Picture three white-coated men standing in front of a computer monitor. While the patient sits directly behind them holding a magnet to her chest, the doctors use the computer to make adjustments to a pacemaker implanted under her skin. The doctors speak continuously, but only among themselves. At the end of the session, one of the men turns to address the patient briefly. He does not bother to explain what he and his colleagues have been doing, but merely asks the woman for the magnet. She does not have to come in again, he explains, since nothing more can be done.

This is exactly what she was told on two previous occasions. After this, her third visit, she is tempted to divulge to them that she doesn't believe their words. But since they literally hold her life in their hands, she remains silent and walks out, feeling like a mere envelope of flesh in which a mechanical item of interest to them had been delivered for revision.

No wonder a recent Rand Corporation study showed that doctors' recommendations are not followed by their patients 45 per cent of the time.

Four months prior to this visit, all I needed (for I was indeed this patient) was a replacement battery for the pacemaker that my surgeon had implanted eleven years ago. On the morning of this surgical procedure, I asked the anesthesiologist if I could have just local anesthesia. He consented and said he would still have to insert a line for IV access, just in case my labile blood pressure were to go haywire. I asked him how many patients chose local over general anesthesia. "About half," he said.

Soon I found myself lying on the operating table, my left chest bare and cold, with a high barrier of blue cloth draped between my face and chest. Voices from the other side of the blue barrier were readily within earshot.

"Let's get started," came a deep male voice. Was that my surgeon? Whoever it was had not ventured to peek around the blue barrier to make eye-contact with me. I felt some tugging on the skin of my chest. Again the male voice spoke, demanding "a mosquito clamp." Good grief, I thought, we must be in the tropics. The next thing the voice ordered was "a wrench." A wrench! What on earth for? Could we somehow have moved to a garage? I felt a sudden pressure on the pacemaker. (Later I was informed that at this point my blood pressure had shot up to 200/100.)

Again the same voice demanded a wrench. I occupied myself by trying to phrase a question to ask the surgeon when he came around after the procedure was done. But I needn't have — he never showed his face. Not having said hello, he didn't bother to say goodbye. He simply walked out.

When they wheeled me to the Recovery Room, my blood pressure plummeted to 118/60. I felt dizzy and nauseated. The anesthesiologist, I was told, had pushed a Valium-like drug through my IV line. Sometime later the nurse phoned my husband to tell him that he could pick me up in an hour. When the time came, I was still too wobbly to stand. My husband had to spend time scouting out a parking spot, waiting for me to recover. When the nurse asked again how I felt, I lied. "Fine," I said. All I wanted was to get out of that room, away from that surgeon; out of that hospital, away from all doctors.

For several days I couldn't get warm and felt vaguely miserable. The pacemaker had been set for a rate of 60, and I had difficulty getting my heart to pump any faster. When I finally succeeded, by trudging behind the dog through heavy snow, palpitations ensued. As I had done before, I made an appointment with my surgeon to have the pacemaker's lower rate adjusted upward.

Before the office visit, I wrote my surgeon the kind of letter that our family calls a thundergram, and put it in my purse. But as I sat in the treatment room holding the magnet over the pacemaker in my chest, watching him and the two assistants standing in front of the computer, I decided not to deliver it. Sometimes patients can be saturnine, too. In short, I chickened out.

In my thundergram I didn't cite any objection to the language my surgeon had used in the operating room. I concede that he should be free to use whatever jargon necessary in his discussions with colleagues, even if the words were puzzling to me, his patient. What I objected to was his lack of appropriate behavior. At the very least, I expected him to poke his head around the blue barrier to greet his patient when he arrived in the operating room. This lack of common courtesy made me feel like a slab of meat waiting for the butcher's knife.

My son, a lawyer, told me that it is precisely this type of depersonalization that makes many patients prone to sue too often, and for too much money. My grandson, the doctor, said that some surgeons feel a need to consider themselves superior to other mortals in order to persevere in the practice of surgery after operations with poor outcomes.

Ironically, despite the depersonalization that I felt, first in the operating room and then three times in the examining room, I have chosen the ultimate form of depersonalization for myself: I have willed my body to a teaching hospital, so that my bits and pieces can service an anatomy or research lab, and my pacemaker can find its way into the chest of a clinic patient. What medical students choose to say — or not say — while dissecting my body, what the laboratory assistants choose to say — or not say — while examining my tissues is of no concern to me.

No, what worries me most is that the surgeon who will save the life of another patient by implanting my pacemaker in her chest may not be as good with his voice as he is with his hands.

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