human behavior

An arrogant assumption

Posted in Habits & Manners, Health & Medicine by humanb on April 24, 2010

This past week in med school I learned about anesthetics in the operating theatre. One of our patients on Friday was a sweet-faced 28 year-old Lebanese-Australian boy. I say ‘boy’ because he was small, thin, and soft-spoken, with an air of innocence about him. (Also, I’m older than he is.) The boy had torn the lateral and medial menisci of his knee playing soccer, and was preparing for his second surgery to repair the damage.

As I stood with him in the anesthetic bay outside the operating theatre, I was struck by the extent of his anxiety. The moment he saw the anesthetist he pulled out a photocopy of his previous anesthetic report from behind his back on the hospital bed. He started asking questions about the anesthesia he would get and fretting that he would be given something different. He went on to explain his injury and the details of his past surgery and to express great concern about what would happen to him this time.

As I prepared to insert an intravenous line into his arm, he became more anxious and asked me if I was giving him a drug. I assured him that I was only establishing access to his vein. As I inserted the needle, his sweet face distorted and he began moaning his discomfort. Once I finished, he picked up his running commentary on his situation, looking more and more agitated as time went by.

I’m ashamed to say that I left the anesthetic bay after I inserted his IV line, because his anxiety was beginning to bother me. Had he been an older patient, or a younger one, or a patient who hadn’t already had a successful surgery, or a patient having open surgery, or a patient having a more life threatening surgery, I would have understood and been more sensitive to his anxiety. But this fellow wasn’t actually a boy. He was a grown man – a fit and healthy young man having arthroscopic knee surgery, a very common procedure. Moreover the needle I inserted – granted with less skill than an anesthetist – was only a tiny one. Rather than being compassionate towards his discomfort, I thought about the fact that I voluntarily and routinely donate plasma. This requires having a much bigger needle stuck into my arm for 30 minutes while blood is drained from me and spun into its components in a machine, before my red blood cells are somewhat painfully pushed back into my vein. Instead of thinking about this patient, I was congratulating myself on being ‘tougher’.

What a whinger!’ I was thinking. ‘What a baby.’ If that wasn’t bad enough, my lack of compassion transformed into a blanket judgment against modern men in general, as weak and melodramatic when it comes to pain and sickness. Nurses frequently joke that men are the biggest fainters, and more intolerant of pain. Whether this is true or not, I don’t know, but I was certainly singing that tune on Friday.

So when I returned to the anesthetic bay, I hid my annoyance with his anxiety behind a smile and remarked gently:

This is a very common procedure, you’ve had it once already without problems, and the doctor is very experienced in performing it. Why are you so nervous?

I was expecting him to reply that he hates pain, or that he’s afraid that something (highly unlikely) will go wrong, or that he doesn’t want to be put to sleep. Instead he replied,

I’ll die without soccer.

[Silence.]

Huh.

I thought about that statement after he was put to sleep, and concluded that this guy probably wasn’t a worry-wort or a scaredy-cat by nature after all. And he was probably pretty tough. He had two seriously torn menisci and one surgery already from playing a pretty aggressive sport. His sensitivity to that needle was probably exaggerated by his anxiety about the surgery. And his anxiety about the surgery had nothing to do with cowardice, and everything to do with his desperation to get back on the soccer field.

I’ll die without soccer.

This wasn’t fear of pain or death overwhelming this boy. This was love – love of a game, of a way of life, and of a life-defining activity. This was fear of losing the Self.

But even if he had been a scaredy-cat, or a whinger, or a big-baby, I should have been kinder. I was perfectly kind on the outside, mind you, but my heart wasn’t in it. It should have been.  Had he been a woman, it would have been. Had he been a child, or elderly or critically ill, it would have been. Had he been anyone else but a young-to-middle-aged man, it would have been. I hope.

One of the greatest challenges and achievements in medicine is to become less judgmental. If you form a negative judgment about a patient before you’ve even treated him, how can you ever be certain you’ve treated him well?

This gives a whole new meaning to the guiding principle of medicine:

First, do no harm.

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