Commenting on “Surgeons and Other Physicians: A Cultural Divide,” a reader who recently found himself in an OR with his wife offers his perspective. This is not meant as a rebuttal to Dr. Cohn’s post. I think that the two perspectives are both equally true—and that OR cultures may vary widely, from one hospital to another. I would also like to hear some surgical nurses weigh in.
“jd” writes:
“The domination exhibited by physicians, particularly surgeons, is about far more than verbal abuse and yelling. I don’t doubt those defending their experience who say that they haven’t seen many angry tantrums by surgeons. But I think we’re getting distracted by the most extreme displays so that we miss the very real and dangerous power dynamics here.
“I happen to have just been in the OR a couple of weeks ago with my wife, who was undergoing an emergency C-section. It was performed by obstetricians, as most are. There was one attending and one (I’m guessing) resident who was being trained during the operation. Their tone of voice and demeanor was perfectly pleasant throughout.
“But here’s the thing: as far as they were concerned they were the
center of the universe and everything in that room revolved around
them. The patient and the nurses had the status of objects. They were
oblivious to my wife and I as human beings, and never once spoke to us
in the OR. That would have been fine if they were so focused on the
operation that they didn’t want distractions, but in fact they gabbed
with each other throughout the procedure. I couldn’t believe how many
different things they found to talk about while cutting open and sewing
up my wife. Some of it had to do with training, which is appropriate
though a bit unnerving. Some of it had to do with office gossip,
friends in common, etc., which is quite unprofessional. How many
airline pilots do you know who make a habit of gabbing with their crews
over the intercom throughout a flight? Or imagine that only the pilot
and co-pilot would speak to each other, treating the flight attendants
as worthy of communication only to issue orders.
“But all that was a minor annoyance to me, and I would not have commented on it except for the following: the nurses quite clearly lived in fear of the doctors. This
was cemented for me when I saw two nurses counting up the sponges when
it came time to start sewing up my wife. They went through …17, 18,
19… one is missing. So, they count again. Same number. Count again.
Same number. They talk to each other about a missing rag in perfectly
normal voices 6 feet from me. I hear their concern. The doctors do not,
though they hear each other loud and clear.
“Then, rather than make sure to get the physicians’ attention, the
nurses keep counting. I lost track of how many different times they
poked and rearranged their piles of bloody sponges to try to make the
final one appear. I could see the them laid out in rows on the floor,
and it wasn’t long before their behavior appeared pathological. After
the 7th or 8th counting (who knows) with the exact same result, a nurse
looks up at a doctor plaintively and starts to say something. She
panics and it catches in her throat to make an inarticulate sound, but
since she is only 3 feet from the doctors I still expect one of them to
turn and ask ‘what is it?’ Doesn’t happen.
“So, the nurses go counting again. And again. Meanwhile, the physicians
are busy sewing up my wife. They are probably half-way done when
finally a nurse summons the courage to speak up and say a sponge is
missing.
“The doctors don’t yell at her. They calmly start digging around in the
uterus to find the final sponge. After some effort, they find it. There
is no ‘thanks for pointing that out.’ Or, ‘glad we caught that.’ They
went on as though nothing had happened. Now, you can say the nurses
were just doing their jobs and didn’t need thanking, and that if either
of the physicians were thinking ‘Shit, I almost screwed up’ they
wouldn’t want to admit it in front of everyone, including the patient.
I’m OK with that.
“What I’m not OK with is that the nurses are afraid to speak up and
correct physicians even when it is essential to their job. One nurse
finally overcame her fear this time, but I am not confident that it
will happen every time at that hospital.
“I look back and wonder why I didn’t say anything. It didn’t even occur
to me, because I saw myself as just a spectator and provider of support
to my wife. In retrospect, I should have taken a different attitude,
but it’s hard when you are suddenly thrown into that environment.
(Mother and child are both doing fine now, by the way.)
“The two physicians, I am sure, saw themselves as the paragons of
civility and good manners. How they had their effect on the nurses I
don’t really know. Were they imperious outside of the OR? Did the
attending have a reputation for blowing up when interrupted even if
they didn’t this time? If a nurse interrupts and she is wrong, does she
get punished in more subtle or indirect ways? For all I know, the
physicians are always civil to the nurses’ faces and their intimidation
came from an ability to give them low marks or decide that they don’t
want to work with certain nurses. I don’t know. All I know is that we
had a near miss that came closer to being a hit by the fact that the
nurses were too intimidated to do their jobs efficiently.”
There is a reason the traditional name for the operating room is the operating theater. It has its stars, its supporting cast, and, sometimes, as jd’s thoughtful post shows, its audience. As a medical student I spent several weeks in William Mayo’s personal operating room, still in use in 1974. It was a deep pit surrounded by galleries that old photographs show were often full of spectators. The audience is mostly gone now in modern ORs, but the theatrical tradition (and role playing) still goes on. Part of the cultural issues were are discussing stem from that, I think.
At my hospital, the laps are typically bundled in bags of 5. When counted the nurses will count them twice if the count is incorrect. They will then open the bags and line the laps upon the floor and recount them to make sure that they didn’t put an extra lap in one or one too few lap in another. They will do this twice. At this time the lap count in then incorrect and they’ll let me know. (And yes I usually already know because I can hear them) Then we all look for the lost lap pad. So 4 counts before declaring an incorrect count is standard where I work. But it’s not the incorrect count that you should worry about. because if the count is incorrect then everything essentially stops until the count is correct. It is the correct count that you should worry about.
As to what to talk about during surgery. Well any topic should be fine except those that would be HIPAA violations or would not be appropriate for a public space. Since we operate all the time it isn’t unusual to talk about dinner, or where you might go on vacation etc. It is the same type of banter that might go on in any typical business office setting.
Again apropos aviation, I’d have to look up the exact rules, but the Federal Aviation Regulations forbid any conversation not directly related to safety of flight during takeoff and landing, when any anomaly is present, and IIRC, below 10,000 feet.
The Cockpit Voice Recorder is a 30 minute loop, which, again IIRC, erases when there is weight on the landing gear. Nevertheless, there are too many accident reports where the CVR was recovered from the wreckage, and there was idle chatter just before what is called “controlled flight into ground.”
It would fit with current crew resource management that any member of the team should be able to call out “anomaly” or something equivalent, and all irrelevant conversation instantly stops until the matter is resolved.
That being said, when I have the option, I stay awake during invasive procedures and some surgery. With a surgeon I knew very well, who was also supervising a hand surgery fellow, I watched as much as practical of a radial nerve decompression (they did set up a mirror, and he’d occasionally hold up my arm while my mouth and nose were covered). The surgeon, who we miss very much, was the dean of hand surgery in the DC area, and did talk fairly constantly — making it a teaching procedure not just for the fellow, but for me and for the nurses. There were a few times where he’d say “this is what I am going to do next. Please, no talking”. Not, of course, the right thing for everyone.
R Evans Cowley, the founder of modern shock-trauma, used to recruit nurses saying he couldn’t pay them any more, but they would learn as much as possible, and also he would (and did) solicited their input. One resident cursed at nurses, and Cowley said nothing, until an all-hands staff meeting where he grabbed the resident’s shirt, brought him nose to nose, and gave him a chewing-out, without one word of profanity, that any Marine drill instructor would envy.
During one cardiac cath, with an experimental imaging technique, I also chewed out the chief invasive cardiologist for his taste in music. Country & western was OK, but “Achy Breaky Heart” was not. The English cardiology fellow and I then proceeded to discuss the Biosense mapping of my myocardium in the terms of Norwegian Blue Parrots.
Wow, I didn’t expect this to become it’s own main post! I hope it is useful to at least someone who works in a hospital.
When I saw it on the main page, I immediately realized that I really should have got my wife’s permission before putting this online. She’s seen it now, and is happy with it, so I’m breathing easier.
As for mjl’s comment, I am sure that recounting is an important part of the process at every hospital, because we all make mistakes. The 8+ recounts certainly seemed excessive to me at the time and from your example it seems you would agree. But the bigger problem wasn’t that they counted so many times, but what clearly led them to do it. I saw the unmistakable fear, and I saw how it made the nurses less effective at their jobs.
This, of course, is just one example. I presented it to bring to life how intimidation can exist even when from the physician point of view everything is normal and professional.
But the plural of anecdote is not evidence, and the larger studies on hospital culture and efforts to change it are obviously far more germane than my little story.
Maggie:
Thanks so much for posting jd’s very perceptive (and very frightening) comment. After reading it, I spent several minutes nearly shaking from similar memories of doctors, nurses, and patients and the way they and we relate to each other.
I hope you won’t mind that this comment is long, but jd’s observations brought back so many memories for me. My memories all take place outside the OR, since I have never been inside one. But they are very similar, nonetheless.
I accompanied my husband, a 15-year brain tumor survivor, nearly every step of the way through our odyssey together; much of that time was spent in hospitals.
Like jd, I remember two things very clearly: first, the way patients and their families are ignored by doctors; and second, how terrified nurses are of doctors.
I saved my husband’s life quite a few times, by noticing doctors’ mistakes. However, in most instances, since his doctors were rarely anywhere to be found in the hospital — except, of course, in the OR! — I would have to speak to nurses about the mistakes I caught. And whenever I pointed these errors out, the nurses would try to brush me off. If I persisted, they’d get upset. They obviously didn’t want to face the doctors with my observations; I was quite sure they were afraid.
I remember one particular order a doctor gave a nurse that would have caused my husband’s death, if I hadn’t intervened. I told the nurse, who ignored me. I persisted. Finally I confronted her: “You know that what he told you to do is wrong.” She said she knew I was right, but she still refused pointblank to confront the doctor. Somehow, it got solved; I don’t remember how. All I know is that even thinking about the incident now is painful for me — 7 years later.
But jd’s observation is terrifying on another level, too – a level that is rarely, if ever, discussed:
Because of the way they are taught to think of themselves as “gods on earth,” most doctors practice what I call “physician-centered medicine.” They see most of their interactions with us, their patients, from their own, very narrow, “self-oriented” point of view, which poses many dangers to their patients.
In her “New York Times” Well Blog of October 27, 2007, Tara Parker Pope wrote about an incident where a 79-year-old woman suffered a stroke. The ER doctor told the family there was “nothing else he could do,” causing the woman’s granddaughter to throw up, and the rest of the family to go into premature mourning. The upshot of this true story was that, by the next morning, the old woman was up and walking, and ready to go into rehab! The point Ms. Parker Pope was making was that doctors shouldn’t steal patients’ hope by giving such dire prognoses.
As a 15-year veteran of our healthcare system, and also as a victim of doctors’ all too often physician-centered point of view, my reaction was somewhat different. I saw this ER doctor’s comment as merely “business as usual,” since so many doctors see a patient’s situation through their own personal set of eyes, and their own eyes only. In other words, since the ER doctor felt that he, personally, couldn’t do anything to save the old woman, then no one – or nothing – could save her.
I wrote a comment to that posting, in which I pointed out yet another danger of this kind of physician-centered view of the world. I hope you (and the “New York Times”) won’t mind if I quote from my own comment here! (The full comment may be found at http://well.blogs.nytimes.com/2007/10/22/when-doctors-steal-hope/#comment-2804 . )
Describing yet another downside of doctor-centered medicine, I wrote about how doctors often see things from TOO POSITIVE a viewpoint, again to the detriment of their patients. I wrote:
“I have personally seen several cases where doctors told patients and their families that the patient was ‘operable,’ inferring that things would go well, and that there would therefore be no post-surgical problems. (One doctor even used the phrase ‘a piece of cake,’ when referring to operating on my husband’s second brain tumor.) In several of these cases, including my husband’s, the patient was, indeed, ‘operable,’ from the doctor’s point of view. But, unfortunately, some of these operations led to dire consequences, including non-healing suture lines (my husband) and, in another case (a friend), coma. These dire consequences, by the way, should have been (but weren’t) mentioned by these doctors when they were encouraging their patients to undergo these risky surgeries — surgeries that looked so easy, and so do-able, from the doctors’ points of view. These devastating results quite possibly weren’t even foreseen by these doctors because the surgeries that they themselves would be performing were, from their own personal perspectives, not at all complex.
“Today, as a medical advocate, who tries to make sense of the medical profession through my blog, http://www.HonestMedicine.com, I have thought long and hard about this. Initially very puzzled, I finally realized that my husband’s surgeon had said that the surgery would be, to use his own words, ‘a piece of cake,’ because — as he told me several times — the tumor was very close to the surface. It would, therefore, be very EASY FOR HIM TO REACH.
“Unfortunately, my husband’s skin did not heal for 8 months following this ‘piece of cake’ surgery, and he was left totally disabled, unable to move, for 3-1/2 years, until his death in 2005 at the age of 56.”
Wouldn’t it be great if doctors actually paid attention and listened to us, and saw things from OUR point of view, rather than viewing us (to quote jd), as “objects”?
Julia Schopick
http://www.HonestMedicine.com
This is a ridiculous story full of assumptions. If the count is incorrect, the nurses will always count and recount. If things don’t add up, you tell the surgeon. Surgeon looks around in wound, trying to find it. This happens every day. First you rule out the possibility of a miscount by recounting. Then you look around the room for dropped sponges on the floor. Then you tell the surgeon the count is off.
I don’t get it Maggie. In the scenario you describe it sounds like everyone was doing their job the way it’s supposed to be done. The narrator must possess an incredible amount of psychological insight that he was able to determine that “intimidation” was occurring. You’ve been on this “surgeons are pricks” line of thought lately and both pieces you posted were rather sophomoric. I mean, HalfMD writes up a fictionalized encounter with a fake dean and you cite chunks of the “encounter” as textual “evidence”. Come on now, Maggie. Youre better than this.
Buckeye Surgeon–
I’m sorry you’re offended.
I hope you also read Dr. Cohen’s very thoughtful response to the Cultural Divide.
There is no vendetta against surgeons here. A reader (Dr. Y) sent me a suggestion that I write about the “cultural divide” along with his thoughts about the history of surgery and its importance in U.S. medicine.
I stumbled onto Half M.D’s 1st person account of training, all of which was true except the “Interview with the Dean” (which he quickly disclosed.)
When I posted, I asked for surgeons to respond, saying that I hoped to post reoponses from one or more.
Then I posted Dr. Chris’
reponse.
Meanwhile, j.d. offered a patient’s perspective.
Each of these 1st person accounts is, as jd emphasizes, one person’s perspective. Together, they provide a more rounded picture than either a surgeon, a med student on rotation, a doctor who works with surgeons or a patient could give us.
Of course anecdotes are not data-but as I’ve written in the past, I think a combination of statistics and stories provide the richest picture of realitly. Often my posts are filled with numbers, but I think it’s more interesting for everyone to vary the style of the posts.
Finally, while you say a missing sponge is no big deal “it happens avery day”, it strikes me that from the point of view of a patient’s husband, the event is, inveitably a very big deal.
Assuming the surgeon was aware that the nurses were recounting it might have been appropriate/sensitive for him to turn to the husband and say “Don’t worry, either they’ll find it in the recount, or we will. We’re on top of it.”
By ignoring the nurses and the husband, the surgeon added to the husband’s anxiety.
“Surgeons are pricks” is your characterization/simplification of these posts–certainly not mine.
As I continue to monitor this thread it occurs to me that we are witnessing a preview of something like the moment of catharsis that is being called for during the democratic convention later this month. There are some unhappy people out there and they insist on being heard. Whether or not the cathartic moment can do anything to accurately identify and rectify the cause of their unhappiness becomes almost irrelevant.
Since the initial post strongly posited the premise that it was the “culture” of surgery that was responsible for unacceptable conduct of some surgeons which then may be somehow related to the worsening health care mess, it has provided an opportunity for those holding similar views to contribute. Anecdotal incidents, real or fictitious, are posted to buttress the argument.
It appears to be a manifestation of something that experienced surgeons have lived with all along. If you manage a case perfectly you will have one happy patient, if you have less than a satisfactory outcome, ten people will know about it. That is equally applicable to the reputation of a surgeon, somehow irritate or aggravate one person and all their acquaintances will know about it. This knowledge is something that helps to govern the personal and professional conduct of the great majority of surgeons.
I do not deny that there are some bad apples in the surgical barrel but finding them and eliminating them is a challenge for the American culture not just a deficiency of the surgical specialties. The culture of surgery is and has always been to do better. The Joint Commission is a perpetual reminder of that quest. Indicting the profession and its culture does little to improve the circumstances.
I’m sorry, I just don’t see the point of this whole digression. Alec Baldwin lines from a mediocre thriller like “Malice” don’t add anything to the discussion either. Why don’t we write about “The cultural divide between investment bankers and accountants” and quote Gordon Gekko lines from “Wall Street” as an illuminating example of the societal underpinnings of a trader’s arrogance? Assholes aren’t going to survive very long in the modern american health care scheme, no matter if you’re a surgeon or some other subspecialty. We can wax nostalgic all we want about the bad old days when surgeons were holy terrors, but the reality is that we’ve all moved on. Drudging up old stereotypes doesn’t help at a time when the public’s perception of physician prestige is lower than ever.
To me, Maggie’s original argument could be broken down in this way:
1. American medicine is highly procedure-oriented
2. This orientation is part of the explanation for our increased costs
3. Surgery is the preeminent procedural specialty
4. The hegemony of the proceduralists could be related to the historical hegemony of surgeons
5. Therefore, let’s examine the basis for this hegemony, certain aspects of the history of medicine and surgery. One of these aspects is the question: “Are surgeons different in some ways from other physicians, and, if so, how?
The goal is understanding, not condemning or bashing anyone. To say she is claiming “surgeons are pricks” is a straw man. I think this is an important discussion to have. If it makes some surgeons uncomfortable, that makes it even a more important discussion to have.
As a side point, it seems to me that the perceptions of a nonphysician observer are a useful and valid thing to examine as part of this discussion. jd’s perception is no less real for being medically uninformed in some ways.
Interesting article, Maggie.
I’m an ER nurse, not OR, but I do have a fair amount of experience working with surgeons, and specialists of all types, since many of their cases originiate in the ED.
I’ve worked with surgeons who were difficult, and surgeons who were gems, and everything in between.
I recall being charge nurse one night when a patient came in with necrotising faciaitis of the leg. The first thing the surgeon looked at was the patient’s face sheet. As soon as he realized the patient was self pay, he started trying to transfer the patient. Of course, the patient was not stable for transfer, and needed to go to the OR immediately. Hospital after hospital refused the transfer. The OR team was in the hospital and ready to go. I kept telling the surgeon he needed to take the patient to surgery. He refused. Finally, I called the nursing supervisor, who agreed the patient needed immediate surgery. Again, the surgeon refused. Finally, I told him, “Doctor, perhaps we need to get the Chief of Staff involved in this.” The patient went to surgery. He lost his leg, but he did live.
I have had doctors throw things at me. I have had them verbally abuse me at the nurses station. Even when nurses file complaints, nothing is done. The physician is KING.
Most doctors do not abuse their patients or other health care professionals. But the heirarchy is clearly visible to everyone who works in health care. Look at how doctors are addressed. They are always “Doctor X”. Few physicians encourage staff or their patients to use a first name basis. Other health care professionals are always addressed by patients and each other on a first name basis. Not “Nurse Y” or “Therapist Z,” or even Miss or Mr.
There is almost always a formal relationship between physicians and staff, physicians and patients. That encourages the hierarchy and culture that allows physician abuse to flourish. I’m not advocating a less formal atmosphere. It can serve a useful purpose. I do advocate accountability.
But doctors who think it’s not a problem, and we “need to move on” should work a shift as a nurse, and see what we have to deal with. Ask any nurse, and she can tell you what doctors you can call at night when a patient has a problem, and what physicians are likely to yell and throw a fit just because you’re doing your job.
Panacea, Chris, John A and Buckeye Surgeon–
Thank you all for weighing in.
Panacea– You write:
“Most doctors do not abuse their patients or other health care professionals. But the heirarchy is clearly visible to everyone who works in health care.”
Based on the comments here and elsewhere where these posts have been reprinted, this seems a very accurate assessment. And I believe that Most Surgeons do not abuse the people they are working with.
But there is a clear hierarchy, and that can cause problems.
Though the times are changing, and I think more and more people are understanding that, these days, medicine must be a team sport.
And nurses are a significant part of that team.
Chris–
Thanks for your measured, thoughtful comment. Yes, that is exactly what I was trying to do. I may not have entirely succeeded, my goal was “understanding [the problem], not condemning or bashing anyone.”
Buckeye Surgeon– I have to agree that the speech from Maclice probably didn’t add to the post.
It’s just so over-the-top that it struck me as funny (this is why I put it under the headline “The Stereotype”–this is the exaggerated caricature of the Surgeon as God– much like the “Greed is Good” speech in “Wall Street.”)
But I can see how you would find it offensive.
On the other hand, I agree with Chris that jd’s perspective is not irrelevant: “jd’s perception is no less real for being medically uninformed in some ways.”
And you didn’t reply to my suggestion that it would have been better if the surgeon had turned to j.d. and said something about the re-counting of the sponges, to reassure him that he (the surgeon) was aware of what was going on, and on top of it–if only to allay his anxiety.
Finally, I realize you believe that these posts have been frivolous, but Kevin M.D. (who I think you also respect) has cross-listed the “Cultural Divide” and J.D’s response on his blog.
He, like Chris, is a physician, and I’ve never sensed any prejudice against surgeons on his blog. He also cross-posts you.
So I hope we can agree to disagree about this controversy.
John A–
Please see what I wrote above to Buckeye surgeon. I
am in no way prejudiced against srugeons. I’ve never had a bad surgery. (never had surgery.) My husband has had a couple of very successful out-patient surgeries for sports injuries.
You write: “If you manage a case perfectly you will have one happy patient, if you have less than a satisfactory outcome, ten people will know about it.”
I believe you that this is true. To some degree, this is true for all doctors, but because the risks are so much higher in surgery, surgeons are more likely to have disappointed patients–even though you explained the possible risks very carefully.
I do think that being a surgeon is extremely stressful. And I can only imagine what it is like to be in the middle of an operation trying the second pair of scissors because the first didn’t work.
Hospitals certainly should do a better job of supporting surgeons in terms of making sure that the equipment is there, and is working. And there are other problems . . sometime you might write in about what hospitals need to do to lead to fewer errors and mishaps during surgery.
But, in general, I think everyone in our health care system could do a better job of collaborating with and supporting each other.
I also don’t get the point of this. What was jd doing in the OR during his wife’s surgery? Does he think that he would be in the cockpit during a flight on a commercial airliner? Does he think he would be in the Boardroom during a crucial discussion about a stock that he owns?, etc.
As far as I know, the sponge count is the nurse’s responsibility. Before the nurse interrupted the surgery, she wanted to make sure that the count was not right. I am not sure what jd thinks is wrong with this.
Does jd think that decision making during surgery should be based on a vote? Is this the way that he runs his own business/profession?
As far as the alleged attitude of fear, I can tell you that most OR nurses that I know do NOT live in fear and are not afraid to speak up when necessary.
Legacy Flyer–
You ask “What was jd doing in the OR during his wife’ surgery?”
I take it you are not a doctor. Probably not a father
Perhaps you haven’t heard, but today, husbands are normally present during children-birth, which includes Ceasarians.
Secondly, you should check out the comments by nurses both on the three suregone posts here and on http://www.allnurses.com–which cross-posted the posts here. As did http://www.kevinmd.com, an excellent blog for doctors.
The nurses who have spoken up, both here and on “allnurses” have been people who said–“I am not intimidated. But surgeons have tried to intimidate me–by throwing things at me, by threatening to get me fired, ect. when I spoke up to prevent a mistake.
The nurses who have spoken up on these blogs also say that they have seen other nurses intimidated.
Having done a lot of work with ambulatory surgery centers and surgery group practices, there is much truth on all sides here.
A couple of important things:
The OR director has to a tough tough manager who protects her/his people.
The organization, whatever it is, has to have a real governance process that does not tolerate crap from physicians, from the board on down.
The best person to discipline a physician is another physician, preferably the Medical Director or CMO of whatever that doc is called.
I worked for a surgeon who was well known for his psycho temper, but he never allowed his temper to enter the OR. He was a medical director, and one day he heard that a young surgeon was abusing the nurses. He pulled the boy-wiz aside and told him him would cut off his boy parts if he heard anymore about staff abuse.
On another note, the usual OR chatter should be suspended for something more muted during a C-section – ah, there is an audience.
save-the-rustbelt–
Everything you say sounds very sensible.
In particular the usual chit-chat during a C-section seems inappropriate since there is an audience, and for the parents, it is a pretty special moment.
Maggie-
Just defending my kinsmen. I’ve calmed down and can see some of your points. Nothing, however, in the list that the eminent Dr Christopher Johnson provided was addressed by interviews with fake deans and stories about sponge counts and Alec Baldwin hamming it up on the silverscreen. Anyway, take care.
I am a father of 3 children and was present at all the deliveries. I am also a doctor and have participated in emergency C-sections – albeit many years ago.
I guess time has passed me by, but I am still surprised that a father was present at an “emergency” C-Section. We used to call them “crash” C-Sections and they happened VERY fast.
Perhaps this “emergency” C-Section wasn’t such an emergency. (A topic you can cover another day)
I am also glad that you pointed out that the nurses in this incident were not intimidated (although they claim to know nurses that have been). That corresponds well with what I said: “I can tell you that most OR nurses that I know do NOT live in fear and are not afraid to speak up when necessary.”
Buckeye and Legacy Flyer
Thanks for your comments–
Buckeye–Thanks very much. I’m very glad that you’re no longer angry. Your blog tells me that we agree about many things.
And I think that it’s very important–especially these days–that like-minded people in health care who respect each other stick together, even when we greatly disagree in some areas. In this case, I think our diagreement may be more a matter of style, not substance. (i.e. while I thought I was using speech from “Malice” as an exmaple of over-reaching stereotype, it gave the post the wrong vibe.)
Legacy- Yes, these days, fathers really are there for emergency C sections.
In my expereience (I didn’t have an emergecy c-section but I did have an induced labor that the doctor called for immediately after examing me –and this was many years ago )
as soon as your docor tells you that you need to get to the hospital as fast as possible, your husband either drives you there or meets you there.
These days, men really do want to be there (or feel they should be there) for the birth, whether its a vaginal delivery or a C-section.
I should add that I think men should get a little more pre-delivery counseling. Most of the men I know tell me that they were completely unprepared for how tough labor is. I think it’s great for a woman to have her partner ther, -but if he is freaked out, that really doesn’t help.
There’s probably a separate article to be written about when family, or perhaps other patient advocates, should be present. I must share an anecdote about labor: I did a doubletake when I had a female surgeon, a colleague of my mother’s, tell me she thought it would be enlightening that I had a volvulus (twisted intestine). She explained that the innervation of the intestines and uterus are fairly similar, so, were I ever to be a parent, I should have a fairly good idea of what labor pains felt like.
Apropos of C-section, there has been a long-time discussion on a trauma mailing list, of whether family should be present during resuscitation, especially trauma resuscitation. If there is a consensus, it is that any layman present should have a designated staff support person, such as a social worker or chaplain–who also has the job of removing the individual should panic result.
There are some practical considerations, anywhere in the ER, not just for trauma: is there physical space for someone who is not directly participating? I’ve seen medical students removed from complex situations (I saw it from just outside), because there just wasn’t enough room.
There is the question of staff concentration, which varies with the staff. Some don’t want to be watched even by a spouse who is a physician, and I’m inclined, certainly in extreme circumstances, to give the staff the benefit of the doubt.
More often than not, I’ve been with family and friends in ER situations, often with specific request as an advocate or history-giver. In general, this has been useful. On a few occasions, when the physician involved knew us, in an office or hospital outpatient procedure, I was even grabbed as an extra pair of hands. On one occasion, my ex-wife had a surgical infection, and the initial intervention was in the GYN’s office. I normally was present, as requested, for emotional support during GYN procedures. In this case, it being a Saturday, I was assisting. At one point — and I had been up dealing with this for 26 hours and probably hadn’t eaten in 12 — I was asked to take the wound culture, and I got a bit faint, although it was nothing that I hadn’t seen before.
There are no simple answers. Quite a few clinicians believe it can give closure for a close family member to be present at even an unsuccessful resuscitation. Unless the family member was very well known, and questionably even then, I’d hesitate long and hard for being present for a trauma-induced cardiac arrest, when the only remaining measure is opening the chest, very very quickly, possibly stopping visible hemorrhage with something quick (even a finger in a hole), and manually compressing the heart. That’s pretty ugly even when there’s no emotional involvement.
No object left behind? We’re not there yet.
What happens when an object is unexpectedly left inside a patient after surgery? In some cases patients suffer no adverse effects, in others life-threatening complications can develop. In a effort to avoid this problem and enhance patient safety, various
Wow! I cannot believe that I found this blog! This poor woman and her husband having a C section and the Drs. non-chalantly chatting. How disrespectful to the art of medicine and to the staff and the woman and her loved one! I too had a most awful time in the OR by a most prominent Los Angeles surgeon who used to run the OB in a Major Los Angeles hospital. He led me straight into a septic seizure during my delivery! Why? Because he didn’t want to be liable for his lack of care. While in the hospital he stopped my labor twice because it was 2 AM! And even after the septic seizure and after stopping my labor twice, he went to send me home, at which time, 8 AM, I again went into labor. This time, he decided to “show-up”. Let me tell you one thing…If it wasn’t for a particular nurse, this Dr. wouldn’t have even showed up after the septic seizure. She called upon him from the moment it happened at 5 PM until 9 PM! Finally, he graced us (said sarcastically) with his presence, only to tell me that I “stank” (yes, because a dying person has an odor) and that I was an “embelism waiting to happen”. What he didn’t tell me was what was happening to me, or what specialist I needed to see. Why didn’t he tell me? Because as an “expert witness” he knew that if he told me what was wrong or what expert to see, that he would be liable. So you see, he didn’t care one bit about me, his patient, and my unborn, nor my loving husband and first born. He only cared about himself. He has no problem billing blue cross for a hysterectomy while he does a nip-n-tuck and a vaginal tightening, but when it comes to doing the “right thing”, his selfish, heirarchial attitude prevails. After the experience of almost dying while in labor, I know there is a God, and angels, and I thank them for my wonderful nurse, Mrs. Luke. By the way, my son is healthy. Oh, and to make the situation live on in me, a year later, the Dr. billed me again for my C section! And was billing another patient on my account, and also billed me for a color ultrasound that was unneccesary and unwarranted the week before due date. Am I angry at his performance, yes, Am I angry that no one listened to me in the OR room during my C section for the spinal, yes (now when I breastfeed, if I’m in a certain position, my arms go numb, and I am afraid I may drop the baby!) If only the surgeons and the Drs. would pay attention to the nurses and to us! In the OR, during the C section, I did speak up, my husband did speak up, did the surgeon and anthesialogist and training Dr. listen to me? NO! So now where does that leave the patient? In the almost dead zone, that’s where. Am I still angry? H-E-double toothpicks I am!
It is time that the medical professionals finish with this patronizations! We pay a lot of money to them and it is time that the patient ask and PRETEND what they want. Everybody has to start to be more informed to don’t be fooled by doctors who ,sometimes, are just looking to earn some money on your body. There are good docs too but is really time that we , as patients, start to be assertive. After all they cut/cure your body and your body belong to yourself, thats it.