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Volume 3, Issue 2
Summer 2007:

Under the Scalpel: a view from the other side

P. Ravi Shankar

Cell 2 Soul. 2007 Summer; 3(2):a4

During my final year of medical school, when I took a bad fall and twisted my right knee, I found that I could not fully bend or straighten my leg.

Our family doctor diagnosed a medial meniscus tear and referred me to an orthopedic surgeon. As a medical student who had spent several years learning how to deal with patients, I sat in the waiting room of a polyclinic and found that I was now a patient myself. I was anxious — who would be my doctor, and how would he treat me? Would he be brisk and blunt, perhaps angry; or sympathetic, soft-spoken and kind? What would the doctor say? Would I require surgery? I had no idea.

My doctor turned out to be a middle-aged man dressed in white — white trousers and a white shirt — with a handlebar moustache. He looked rather scary at first; his manner was brisk rather than comforting. Yet he was not unkind. He explained what was wrong with my knee and said that I would require surgery.

I would be admitted to the hospital the night before surgery and taken to the operating theater as the first case the following morning. The next day dawned cloudy. I was told to take a hot bath and scrub my knee and leg before I was prepped for surgery.

In my pharmacology class I had read about thiopentone sodium, the agent used to induce general anesthesia. I had a strange foreboding that thiopentone would not be effective in my case. I feared that it would wear off midway through the procedure, and I envisioned myself waking up in waves of searing white pain.

The anesthetist instructed me to count backwards from one hundred. At ninety-four, I blacked out.

Suddenly I woke up coughing, with vague pain in my throat. At first, I thought that the surgery was still in progress! I looked around and saw my family standing by the bedside. The anesthetist turned out to be a friendly fellow. He had talked to me about thiopentone sodium just before I went under anesthesia, and now he explained that my cough was most likely caused by irritation from the endotracheal tube.

I learned first hand that surgery can be a traumatic experience. Fear is ever present. As a patient, I wanted my questions answered and my doubts clarified. I learned that doctors frequently ignore their patients in the hustle and bustle of the operation theater.

My right lower leg was now bandaged with a plaster splint. Lying in bed, I contemplated the revolutions of the ceiling fan overhead. I felt an irresistible urge to get up, to walk around, to stand on my own two feet; but I could not rise up from the bed.

Three days later the stitches were removed, and I was permitted to move about with a walker. It was sheer bliss finally to be mobile — I never imagined that walking could be such a delight! Being a hospital patient is very boring; I had nothing to do except read. After three days, I had more than enough; I was desperate to go home.

Although I was supposed to leave the hospital on the afternoon of the fourth day, I was not released. I heard them say something about my wound requiring further observation. I had often wondered why patients were so desperate to go home — now I knew.

The next day I was discharged. I had to return to the polyclinic for regular follow-up visits with my doctor. After ten days the orthopedic surgeon ordered the mobilization of my knee joint. Initially I was quite happy that I would finally be permitted to move my knee, not realizing what lay in store for me.

The physical therapist was a jolly good fellow. He taught me to do various exercises to strengthen my quadriceps muscles, which had atrophied after the surgery. For me the worst part was mobilizing the joint. The therapist would passively flex the joint, gradually increasing the range of motion at the knee. The pain was unbearable!

I will always have a secret sympathy for the patient who undergoes physical therapy. I resolved that I would always explain to my patients what to expect before writing the order to 'mobilize' a joint. Although still weak with occasional knee pain, I gradually limped back to normal.

What did this experience teach me? That patients feel vulnerable, and need to be handled with sympathy and understanding. Sometimes in our busy professional lives we forget the concerns of the patient. Caught up in the complexities of our work, we may not see things from the patient's perspective. I resolved that I would be a kinder, more understanding doctor.

Looking back, I think that on the whole I have been able to live up to my vow, although sometimes I fail miserably. Medicine is a life-long process of learning, and as frail humans, we sometimes falter.

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